Organization
PROFESSIONAL DENTAL SLC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT D HACK (OWNER)
(801) 636-0110
Entity
Organization
Contact information
Practice address
1632 W 700 N STE A-1, SALT LAKE CITY, UT 84116-1903
(801) 785-8000
(801) 785-4030
Mailing address
PO BOX 1806, OREM, UT 84059-1806
(801) 785-8000
(801) 785-4030
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/16/2024
Last updated
07/19/2024
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