Organization
OUT OF THIS WORLD DENTISTRY WJ PC
Active
Parent organization
OUT OF THIS WORLD DENTISTRY PC
Other names
Out of This World Dentistry WJ
Organization subpart
Yes
Provider details
NPI number
Legal business name
OUT OF THIS WORLD DENTISTRY PC
Authorized official
DANNIELLE STARK (OFFICE MANAGER)
(801) 898-7502
Entity
Organization
Contact information
Practice address
6787 S REDWOOD RD, SUITE #100, WEST JORDAN, UT 84084-2404
(801) 542-7009
(801) 748-0920
Mailing address
6787 S REDWOOD RD, SUITE #100, WEST JORDAN, UT 84084-2404
(801) 542-7009
(801) 748-0920
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
144937
UT
Other
Enumeration date
08/20/2014
Last updated
08/20/2014
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