Organization
104 WEST DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL NELSON DDS (MEMBER)
(435) 734-2394
Entity
Organization
Contact information
Practice address
104 W 200 S, BRIGHAM CITY, UT 84302-2506
(435) 734-2394
(435) 734-0117
Mailing address
104 W 200 S, BRIGHAM CITY, UT 84302-2506
(435) 734-2394
(435) 734-0117
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/03/2025
Last updated
12/03/2025
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