Organization
OUT OF THIS WORLD DENTISTRY PC
Active
Other names
Out of This World Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DANNIELLE STARK (OFFICE MANAGER)
(801) 898-7502
Entity
Organization
Contact information
Practice address
112 E 12450 S STE 100, DRAPER, UT 84020-8057
(801) 571-6751
(801) 571-4156
Mailing address
112 E 12450 S STE 100, DRAPER, UT 84020-8057
(801) 571-6751
(801) 571-4156
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
144937
UT
Other
Enumeration date
08/21/2014
Last updated
08/21/2014
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