Organization
BOUNTIFUL DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK NELSON (PART OWNER)
(801) 295-8322
Entity
Organization
Contact information
Practice address
625 E 500 S, SUITE 201, BOUNTIFUL, UT 84010-3882
(801) 292-0443
Mailing address
625 E 500 S, SUITE 201, BOUNTIFUL, UT 84010-3882
(801) 292-0443
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2013-45880
UT
Other
Enumeration date
08/02/2013
Last updated
08/02/2013
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