Organization
MAGNA DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN S JOHNSON (OWNER)
(801) 250-1717
Entity
Organization
Contact information
Practice address
3564 S 7200 W STE B, MAGNA, UT 84044-3507
(801) 250-1717
(801) 250-6098
Mailing address
3564 S 7200 W STE B, MAGNA, UT 84044-3507
(801) 250-1717
(801) 250-6098
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
137173
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881802494
—
UT
Enumeration date
05/05/2011
Last updated
05/05/2011
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