Organization
STATE OF UTAH, DEPARTMENT OF HEALTH
Active
Other names
Family Dental Plan
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID SUNDWALL M.D. (EXECUTIVE DIRECTOR)
(801) 538-6111
Entity
Organization
Contact information
Practice address
SALT LAKE CLINIC - FAMILY DENTAL PLAN, 3195 SOUTH MAIN STREET, SUITE 200, SALT LAKE CITY, UT 84114
(801) 468-0342
Mailing address
288 NORTH 1460 WEST, P.O. BOX 143107, SALT LAKE CITY, UT 84114-3107
(801) 538-6111
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/06/2006
Last updated
08/22/2020
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