Organization
SALT LAKE DONATED DENTAL SERVICES
Active
Other names
SLDDS
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STEPHANIE M. JENSEN (EXECUTIVE DIRECTOR)
(801) 983-0351
Entity
Organization
Contact information
Practice address
1383 S 900 W, SUITE 128, SALT LAKE CITY, UT 84104-1603
(801) 983-0350
(801) 983-0353
Mailing address
1383 S 900 W, SUITE 128, SALT LAKE CITY, UT 84104-1603
(801) 983-0350
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
870422710002
—
UT
Enumeration date
01/13/2009
Last updated
01/16/2009
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