Organization
SOUTHTOWN ENDODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS MARK VAN DEN BERGHE DDS (OWNER)
(801) 233-0503
Entity
Organization
Contact information
Practice address
45 W 10000 S, SUITE 305, SANDY, UT 84070
(801) 233-0503
(801) 233-0593
Mailing address
45 W 10000 S, SUITE 305, SANDY, UT 84070
(801) 233-0503
(801) 233-0593
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
55467
UT
Other
Enumeration date
08/09/2006
Last updated
08/22/2020
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