# CREEK ROAD ORTHODONTICS AND PEDIATRIC DENTISTRY

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

## Provider details

- **NPI number:** 1912274051
- **Authorized official:** DR. BARNEY TODD OLSEN D.D.S., M.S. (DENTIST/OWNER)
- **Authorized official phone:** (801) 562-5505

## Contact information

- **Practice address:** 7410 CREEK RD, SUITE \#200, SANDY, UT 84093-6140
- **Practice address phone:** (801) 562-5505
- **Mailing address:** 7410 CREEK RD, SUITE \#200, SANDY, UT 84093-6140
- **Mailing address phone:** (801) 562-5505

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 76505 | UT | Yes |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | 76505 | UT | — |

## Other

- **Enumeration date:** 11/17/2011
- **Last updated:** 11/17/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 528962557001 | — | UT |