Organization
PONY EXRESS ORTHODONTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA GARNER (DIRECTOR OF OPERATIONS)
(801) 614-7669
Entity
Organization
Contact information
Practice address
5396 W DAYBREAK PKWY, SOUTH JORDAN, UT 84009-5900
(801) 614-7669
Mailing address
5396 W DAYBREAK PKWY, SOUTH JORDAN, UT 84009-5900
(801) 614-7669
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
05/08/2018
Last updated
05/08/2018
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