Organization
SUGAR HOUSE DENTAL MANAGEMENT LLC
Active
Other names
The Sugar House Dentist
Organization subpart
No
Provider details
NPI number
Authorized official
JARED THEURER DDS (DOCTOR)
(801) 486-9649
Entity
Organization
Contact information
Practice address
1955 S 1300 E STE L2, SALT LAKE CITY, UT 84105-3675
(801) 486-9649
(801) 486-9640
Mailing address
1955 S 1300 E STE L2, SALT LAKE CITY, UT 84105-3675
(801) 486-9649
(801) 486-9640
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
305R00000X
Preferred Provider Organization
337770
UT
305R00000X
Preferred Provider Organization
9361973
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023423258
NPI
UT
01
—
1700897428
NPI
UT
Enumeration date
12/23/2015
Last updated
04/06/2023
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