Organization
BONNEVILLE PREVENTIVE DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW WOLPERT DMD (DIRECTOR)
(801) 627-0420
Entity
Organization
Contact information
Practice address
3860 JACKSON AVE, SUITE 6, OGDEN, UT 84403-1956
(801) 627-0420
Mailing address
3860 JACKSON AVE, SUITE 6, OGDEN, UT 84403-1956
(801) 627-0420
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
8289908
UT
Other
Enumeration date
05/01/2013
Last updated
05/01/2013
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