# OUT OF THIS WORLD DENTISTRY SJ PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** OUT OF THIS WORLD DENTISTRY PC
- **Other names:** Out of This World SJ
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1811396260
- **Legal business name:** OUT OF THIS WORLD DENTISTRY PC
- **Authorized official:** CORY STARK DDS (OWNER)
- **Authorized official phone:** (801) 260-0400

## Contact information

- **Practice address:** 10426 S. 4000 W., SOUTH JORDAN, UT 84009
- **Practice address phone:** (801) 260-0400
- **Practice address fax:** (801) 619-5399
- **Mailing address:** 10426 S. 4000 W., SOUTH JORDAN, UT 84009
- **Mailing address phone:** (801) 260-0400
- **Mailing address fax:** (801) 619-5399

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 08/21/2014
- **Last updated:** 07/21/2022