Organization
BKP DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHUNG CHAU (OWNER MANAGER)
(801) 541-6807
Entity
Organization
Contact information
Practice address
4066 S 4000 W, SALT LAKE CITY, UT 84120-4040
(801) 968-2864
Mailing address
4066 S 4000 W, SALT LAKE CITY, UT 84120-4040
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
5660293-9922
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528832224001
—
UT
Enumeration date
10/14/2013
Last updated
10/14/2013
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