Organization
SIMPLY WISDOM TEETH PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NIELS HENDRICKSON (MANAGER)
(435) 215-6621
Entity
Organization
Contact information
Practice address
352 E RIVERSIDE DR STE A9, SAINT GEORGE, UT 84790-5812
(435) 652-1243
(435) 652-1243
Mailing address
352 E RIVERSIDE DR STE A9, SAINT GEORGE, UT 84790-5812
(435) 652-1243
(435) 652-1243
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
143297
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528948205
—
UT
Enumeration date
08/16/2017
Last updated
07/21/2022
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