Organization
STANSBURY PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCI NICOL (VP OF OPERATIONS)
(801) 918-4135
Entity
Organization
Contact information
Practice address
220 MILLPOND, SUITE #107, STANSBURY PARK, UT 84074-9745
(435) 843-5437
Mailing address
220 MILLPOND, SUITE #107, STANSBURY PARK, UT 84074-9745
(435) 843-5437
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/18/2013
Last updated
12/18/2013
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