# WASATCH ENDODONTICS, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821428921
- **Authorized official:** BRADY J OLSEN D.M.D. (OWNER)
- **Authorized official phone:** (801) 298-1101

## Contact information

- **Practice address:** 185 S 400 E, SUITE 201, BOUNTIFUL, UT 84010-4801
- **Practice address phone:** (801) 298-1101
- **Practice address fax:** (801) 298-1104
- **Mailing address:** 185 S 400 E, SUITE 201, BOUNTIFUL, UT 84010-4801
- **Mailing address phone:** (801) 298-1101
- **Mailing address fax:** (801) 298-1104

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | 7270739-9922 | UT | Yes |

## Other

- **Enumeration date:** 11/26/2013
- **Last updated:** 11/26/2013