Organization
WHITE PINE ENDODONTICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORDAN HANSEN DDS (PRESIDENT)
(435) 760-4346
Entity
Organization
Contact information
Practice address
169 N GATEWAY DR STE 200, PROVIDENCE, UT 84332-9516
(435) 760-4346
Mailing address
169 N GATEWAY DR STE 200, PROVIDENCE, UT 84332-9516
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
8362186-9922
UT
Other
Enumeration date
07/25/2017
Last updated
07/25/2017
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