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Organization

SOUTH VALLEY PEDIATRIC DENTISTRY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. ANGIE CATMULL (OFFICE MANAGER)
(801) 489-1301
Entity
Organization

Contact information

Practice address
1795 W 500 S, SUITE B3, SPRINGVILLE, UT 84663-3186
(801) 489-1301
Mailing address
1795 W. 500 S., SUITE B3, SPRINGVILLE, UT 84663
(801) 489-1301

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
582779657001
UT
Enumeration date
04/09/2010
Last updated
04/09/2010
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