Organization
SALT LAKE PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY RUPP (OWNER)
(801) 463-1900
Entity
Organization
Contact information
Practice address
1548 E 4500 S STE 102, SALT LAKE CITY, UT 84117-5209
(801) 463-1900
Mailing address
1548 E 4500 S STE 102, SALT LAKE CITY, UT 84117-5209
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6273877
UT
122300000X
Dentist
7348465
UT
Other
Enumeration date
08/01/2014
Last updated
08/01/2014
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