Organization
LEGACY FAMILY DENTAL OF BOUNTIFUL LLC
Active
Organization
LEGACY FAMILY DENTAL OF BOUNTIFUL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KASE PEERY (OWNER/MANAGING MEMBER)
(801) 870-0838
Entity
Organization
Contact information
Practice address
55 E 2200 S, BOUNTIFUL, UT 84010-5619
(801) 295-5115
(801) 397-5559
Mailing address
55 E 2200 S, BOUNTIFUL, UT 84010-5619
(801) 295-5115
(801) 397-5559
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
75313980160
UT
Other
Enumeration date
04/12/2010
Last updated
04/12/2010
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