Organization
GENESIS DENTAL OF SALT LAKE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON D CASTO (OWNER/MEMBER)
(801) 870-0625
Entity
Organization
Contact information
Practice address
420 E SOUTH TEMPLE STE 220, SALT LAKE CITY, UT 84111-1329
(801) 355-3286
(801) 355-1320
Mailing address
12180 S 300 E UNIT 270, DRAPER, UT 84020-2612
(801) 870-0625
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/29/2006
Last updated
03/26/2024
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