Organization
MAGNA PDC PLLC
Active
Other names
Main Street Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MARK CHRISTENSEN (CREDENTIALING SPECIALIST)
(801) 691-1701
Entity
Organization
Contact information
Practice address
9010 W MAGNA MAIN ST, MAGNA, UT 84044-1002
(801) 250-7311
Mailing address
PO BOX 970098, OREM, UT 84097-0014
(801) 691-1701
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/21/2023
Last updated
11/21/2023
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