Organization
WASATCH ENDODONTICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADY J OLSEN D.M.D. (OWNER)
(801) 298-1101
Entity
Organization
Contact information
Practice address
185 S 400 E, SUITE 201, BOUNTIFUL, UT 84010-4801
(801) 298-1101
(801) 298-1104
Mailing address
185 S 400 E, SUITE 201, BOUNTIFUL, UT 84010-4801
(801) 298-1101
(801) 298-1104
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
7270739-9922
UT
Other
Enumeration date
11/26/2013
Last updated
11/26/2013
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