Organization
STANSBURY DENTAL AND IMPLANT CENTER PDC PLLC
Active
Other names
Stansbury Dental and Implant Center
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB WARNER (CREDENTIALING MANAGER)
(801) 691-1701
Entity
Organization
Contact information
Practice address
263 COUNTRY CLUB DR., SUITE 103, STANSBURY PARK, UT 84074-9600
(432) 882-2850
Mailing address
PO BOX 970596, OREM, UT 84097-0309
(801) 305-3460
(801) 335-6551
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
341237
UT
122300000X
Dentist
Primary
—
—
1223P0300X
Periodontics
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
07/15/2013
Last updated
12/19/2019
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