Organization
NIC - SALT LAKE CITY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEX SWANSON (CEO)
(801) 510-9145
Entity
Organization
Contact information
Practice address
7138 S HIGHLAND DR STE 109, SALT LAKE CITY, UT 84121-3776
(801) 942-7770
Mailing address
7138 S HIGHLAND DR STE 109, SALT LAKE CITY, UT 84121-3776
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
04/28/2020
Last updated
08/10/2020
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