Organization
BLUE MOUNTAIN FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN TODD HILMO D.D.S (GENERAL DENTIST)
(801) 356-7329
Entity
Organization
Contact information
Practice address
1675 N 200 W #8A, PROVO, UT 84604
(801) 356-7329
Mailing address
1675 N 200 W #8A, PROVO, UT 84604
(801) 356-7329
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7369645
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
050828
—
UT
Enumeration date
01/26/2015
Last updated
01/26/2015
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