Organization
MODERN DENTAL PROFESSIONALS UT, PC
Active
Parent organization
MODERN DENTAL PROFESSIONALS UT, PC
Other names
Monarch Dental - South Ogden
Organization subpart
Yes
Provider details
NPI number
Legal business name
MODERN DENTAL PROFESSIONALS UT, PC
Authorized official
LILIANA MARTINEZ (CREDENTIALING DIRECTOR)
(493) 089-7929
Entity
Organization
Contact information
Practice address
5974 S. FASHION POINTE DRIVE, SUITE 210, SOUTH OGDEN, UT 84403
(801) 475-6121
(801) 471-0919
Mailing address
8415 DATAPOINT DRIVE, SUITE 1020, SAN ANTONIO, TX 78229
(714) 578-6358
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
141895-9921
UT
Other
Enumeration date
05/20/2016
Last updated
04/08/2024
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