Individual
MORGAN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
223 S 700 E STE 3, SALT LAKE CITY, UT 84102-2174
(801) 355-6997
Mailing address
223 S 700 E STE 3, SALT LAKE CITY, UT 84102-2174
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11301868-9922
UT
Other
Enumeration date
06/24/2019
Last updated
06/24/2019
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