Organization
GREAT SMILES DENTAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSHUA RODRIGGS (GMP)
(385) 355-1434
Entity
Organization
Contact information
Practice address
7410 S CREEK RD, #303, SANDY, UT 84093-6140
(801) 642-4080
Mailing address
333 E MAIN ST, #351, LEHI, UT 84043-4200
(801) 642-4080
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9030705
UT
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
135181
UT
Other
Enumeration date
11/06/2015
Last updated
11/06/2015
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