Organization
PROFESSIONAL DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT D HACK (OWNER)
(801) 785-8000
Entity
Organization
Contact information
Practice address
78 E 100 S, PAYSON, UT 84651-2262
(801) 465-0550
(801) 465-9475
Mailing address
PO BOX 1715, OREM, UT 84059-1715
(801) 785-8000
(801) 465-9475
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
56928280160
UT
Other
Enumeration date
03/20/2007
Last updated
03/10/2017
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