Organization
PONY EXPRESS DENTAL LLC
Active
Parent organization
LAKE MOUNTAIN HEALTH, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKE MOUNTAIN HEALTH, LLC
Authorized official
DR. MICHAEL S TORNOW DMD (COO)
(505) 947-4252
Entity
Organization
Contact information
Practice address
1308 E. EAGLE MOUNTAIN BLVD, EAGLE MOUNTAIN, UT 84005
(801) 876-7669
Mailing address
219 E 12300 S, SUITE I-5, DRAPER, UT 84020-6970
(801) 789-7669
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
5015649
UT
Other
Enumeration date
02/14/2017
Last updated
03/16/2017
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