Organization
JORDAN RIDGE 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
678 E. VINE STREET, SUITE #10, MURRAY, UT 84107
(801) 918-4135
Mailing address
678 E VINE ST, SUITE #10, MURRAY, UT 84107-5546
(801) 918-4135
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/28/2016
Last updated
08/28/2016
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