Organization
M KELLY SOUTAS DMD PC
Active
Other names
A Place To Smile
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL KELLY SOUTAS DMD (PRESIDENT)
(801) 489-6811
Entity
Organization
Contact information
Practice address
485 S MAIN ST, STE 302, SPRINGVILLE, UT 84663-2279
(801) 489-6811
(801) 489-6840
Mailing address
485 S MAIN ST, STE 302, SPRINGVILLE, UT 84663-2279
(801) 489-6811
(801) 489-6840
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
374892
UT
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
09/08/2015
Last updated
09/08/2015
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