Organization
WASATCH DENTAL ASSOCIATION, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURENCE R PALMER D.D.S. (OWNER)
(801) 394-0401
Entity
Organization
Contact information
Practice address
1245 CAPITOL ST, SUITE 106-S, OGDEN, UT 84401-2847
(801) 394-0401
(801) 394-0644
Mailing address
1245 CAPITOL ST, SUITE 106-S, OGDEN, UT 84401-2847
(801) 394-0401
(801) 394-0644
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
144526
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
518883937000
—
UT
Enumeration date
10/27/2010
Last updated
10/27/2010
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