Organization
EASTGATE PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCI NICOL (VP OF OPERATIONS)
(801) 918-4135
Entity
Organization
Contact information
Practice address
1580 E 3900 S, SUITE #110, SLC, UT 84124-1581
(801) 272-8555
Mailing address
1580 E 3900 S, SUITE #110, SLC, UT 84124-1581
(801) 272-8555
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/18/2013
Last updated
12/18/2013
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