Organization
WISDOM TEETH ONLY
Active
Other names
Dr. Wisdom Teeth
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELIZABETH GARCIA (OFFICE MANAGER)
(801) 370-0050
Entity
Organization
Contact information
Practice address
2230 N UNIVERSITY PKWY STE 8A, PROVO, UT 84604-6702
(801) 370-0050
(801) 370-9635
Mailing address
2230 N UNIVERSITY PKWY STE 8A, PROVO, UT 84604-6702
(801) 370-0050
(801) 370-9635
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
134055
UT
122300000X
Dentist
Primary
5136597
UT
364S00000X
Clinical Nurse Specialist
187982
UT
364S00000X
Clinical Nurse Specialist
5594772
UT
Other
Enumeration date
10/10/2016
Last updated
10/10/2016
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