Organization
PACIFIC WEST DENTAL GROUP
Active
Other names
Atlantis Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CATHILYN SELF (INSURANCE COORDINATOR)
(801) 614-0099
Entity
Organization
Contact information
Practice address
1792 W 1700 S STE 101, SYRACUSE, UT 84075-9650
(801) 614-0099
(801) 776-3661
Mailing address
1792 W 1700 S STE 101, SYRACUSE, UT 84075-9650
(801) 614-0099
(801) 776-3661
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
4921068
UT
Other
Enumeration date
02/08/2012
Last updated
01/04/2016
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