Organization
CANYON DENTAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BART WILSON WOLTHUIS DDS (DR.)
(801) 399-5831
Entity
Organization
Contact information
Practice address
512 12TH ST, OGDEN, UT 84404-5803
(801) 399-5831
(801) 409-0134
Mailing address
512 12TH ST, OGDEN, UT 84404-5803
(801) 399-5831
(801) 409-0134
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
140299
UT
Other
Enumeration date
06/23/2014
Last updated
06/23/2014
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