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Organization

COLLEGE DENTAL CLINIC LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KENNETH MOLEN DDS (OWNER)
(801) 426-0774
Entity
Organization

Contact information

Practice address
1176 S 1480 W, OREM, UT 84058-4905
(801) 426-0774
Mailing address
1176 S 1480 W, OREM, UT 84058-4905
(801) 426-0774

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
9317729
UT

Other

Enumeration date
04/28/2015
Last updated
04/28/2015
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