Organization
PROFESSIONAL DENTAL CIRCLEVILLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT D HACK (OWNER)
(801) 785-8000
Entity
Organization
Contact information
Practice address
110 SOUTH 100 EAST, CIRCLEVILLE, UT 84723
(801) 785-8000
Mailing address
PO BOX 1806, OREM, UT 84059-1806
(801) 785-8000
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1942396643
NPI
UT
Enumeration date
05/08/2021
Last updated
05/10/2021
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