Organization
STONEHAVEN DENTAL - MAPLETON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COREZ LOGAN (CREDENTIALING SPECIALIST)
(502) 254-8500
Entity
Organization
Contact information
Practice address
425 N MAIN ST, MAPLETON, UT 84664-3410
(502) 254-8500
Mailing address
425 N MAIN ST, MAPLETON, UT 84664-3410
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
UT
Other
Enumeration date
11/05/2014
Last updated
11/05/2014
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