Organization
GREATER ENDODONTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL MADSEN DDS (MANAGING MEMBER)
(801) 268-3636
Entity
Organization
Contact information
Practice address
5334 SOUTH WOODROW STREET, SUITE 201, SALT LAKE CITY, UT 84107
(801) 268-3636
(801) 942-7652
Mailing address
P.O. BOX 71277, SALT LAKE CITY, UT 84171
(801) 268-3636
(801) 942-7652
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
5639652
UT
1223E0200X
Endodontics
77525365
UT
Other
Enumeration date
12/04/2017
Last updated
12/04/2017
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