Organization
A PERFECT SMILE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARVIN BLANE JACKSON DDS (PRESIDENT)
(801) 210-2568
Entity
Organization
Contact information
Practice address
230 N FAIRGROUNDS RD, PRICE, UT 84501-4205
(435) 637-2100
(435) 637-5007
Mailing address
230 N FAIRGROUNDS RD, PRICE, UT 84501-4205
(435) 637-2100
(435) 637-5007
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
6605138
UT
Other
Enumeration date
04/21/2015
Last updated
04/21/2015
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