Organization
SOUTH OGEN PDC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB WARNER (CREDENTIALING MANAGER)
(801) 691-1701
Entity
Organization
Contact information
Practice address
5300 ADAMS AVE PKWY, OGDEN, UT 84405-6902
(801) 476-1234
Mailing address
PO BOX 970328, OREM, UT 84097-0309
(801) 476-1234
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/06/2020
Last updated
06/06/2020
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