Organization
MAIN STREET DENTAL OF SALT LAKE CITY
Active
Other names
Main Street Dental of Salt Lake City
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER D WILSON (MANAGER/OWNER)
(801) 792-6033
Entity
Organization
Contact information
Practice address
3195 S MAIN ST STE 201, SALT LAKE CITY, UT 84115-3749
(801) 792-6033
Mailing address
7922 S GOLDENPOINTE WAY, WEST JORDAN, UT 84088-7672
(801) 792-6033
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
08/27/2015
Last updated
08/27/2015
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