Organization
GENESIS ORTHODONTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON D CASTO (MEMBER/OWNER)
(801) 870-0625
Entity
Organization
Contact information
Practice address
3725 W 4100 S STE 240, WEST VALLEY CITY, UT 84120-5530
(801) 969-9070
Mailing address
12180 S 300 E UNIT 270, DRAPER, UT 84020-2612
(801) 969-9070
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
144139
UT
Other
Enumeration date
04/04/2018
Last updated
03/26/2024
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