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Organization

FRESH START DENTAL CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ROGER WHITEHOUSE (CEO)
(801) 598-3333
Entity
Organization

Contact information

Practice address
6287 S REDWOOD RD, TAYLORSVILLE, UT 84123-6634
(801) 313-1144
(801) 313-1141
Mailing address
6287 S REDWOOD RD, TAYLORSVILLE, UT 84123-6634
(801) 313-1144
(801) 313-1141

Taxonomy

Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
12752998-002
UT

Other

Enumeration date
03/02/2010
Last updated
03/02/2010
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