Organization
INTERMOUNTAIN DENTAL ASSOCIATES - SURGICAL ASSOCIATES
Active
Parent organization
INTERMOUNTAIN DENTAL ASSOCIATES SPECIALTY LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
INTERMOUNTAIN DENTAL ASSOCIATES SPECIALTY LLC
Authorized official
VICKI LEWIS (SPECIALIST COORDINATOR)
(801) 782-5682
Entity
Organization
Contact information
Practice address
2721 N 400 E, SUITE 2, NORTH OGDEN, UT 84414-2393
(801) 782-5682
(801) 786-0520
Mailing address
2721 N 400 E, SUITE 2, NORTH OGDEN, UT 84414-2393
(801) 782-5682
(801) 786-0520
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
144024-9922
UT
Other
Enumeration date
12/06/2011
Last updated
12/06/2011
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