Organization
CENTRAL FOSSA LLC
Active
Other names
Creek Road Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
AMY E. FLORANCE DETHORN DMD (OWNER)
(801) 566-5577
Entity
Organization
Contact information
Practice address
7369 CREEK ROAD, SANDY, UT 84121
(801) 566-5577
(801) 566-4848
Mailing address
7369 CREEK ROAD, SANDY, UT 84121
(801) 566-5577
(801) 566-4848
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8628346
UT
Other
Enumeration date
07/23/2013
Last updated
07/23/2013
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