Organization
MOORE LEGACY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELISE NICOLE VAN TASSELL (OWNER)
(385) 239-0028
Entity
Organization
Contact information
Practice address
4896 S 1900 W STE B, ROY, UT 84067-2994
(801) 773-9198
(208) 444-9804
Mailing address
4896 S 1900 W STE B, ROY, UT 84067-2994
(801) 773-9198
(208) 444-9804
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/04/2023
Last updated
08/04/2023
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