# PACIFIC WEST DENTAL GROUP

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Atlantis Pediatric Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811269756
- **Authorized official:** MRS. CATHILYN SELF (INSURANCE COORDINATOR)
- **Authorized official phone:** (801) 614-0099

## Contact information

- **Practice address:** 1792 W 1700 S STE 101, SYRACUSE, UT 84075-9650
- **Practice address phone:** (801) 614-0099
- **Practice address fax:** (801) 776-3661
- **Mailing address:** 1792 W 1700 S STE 101, SYRACUSE, UT 84075-9650
- **Mailing address phone:** (801) 614-0099
- **Mailing address fax:** (801) 776-3661

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 4921068 | UT | Yes |

## Other

- **Enumeration date:** 02/08/2012
- **Last updated:** 01/04/2016