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Organization

INTERMOUNTAIN DENTAL ASSOCIATES -PERIODONTICS

Active
Parent organization
INTERMOUNTAIN DENTAL ASSOCIATES SPECIALTY
Organization subpart
Yes

Provider details

NPI number
Legal business name
INTERMOUNTAIN DENTAL ASSOCIATES SPECIALTY
Authorized official
VICKI LEWIS (SPECIALIST COORDINATOR)
(801) 782-5682
Entity
Organization

Contact information

Practice address
2721 N 400 E, SUITE 2, NORTH OGDEN, UT 84414-2393
(801) 782-5682
(801) 786-0520
Mailing address
2721 N 400 E, SUITE 2, NORTH OGDEN, UT 84414-2393
(801) 782-5682
(801) 786-0520

Taxonomy

Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
144024-9922
UT

Other

Enumeration date
12/06/2011
Last updated
12/06/2011
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