Organization
WAYNE COMMUNITY HEALTH CENTERS, INC
Active
Other names
EscaLante Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EVAN CHRISTENSEN (CEO)
(435) 425-1102
Entity
Organization
Contact information
Practice address
65 NORTH CENTER STREET, ESCALANTE, UT 84776-0276
(435) 826-4333
(435) 826-4336
Mailing address
PO BOX 303, BICKNELL, UT 84715-0303
(435) 425-3744
(435) 425-1138
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
UT
261QF0400X
Federally Qualified Health Center (FQHC)
—
UT
261QM1300X
Multi-Specialty Clinic/Center
—
UT
Other
Enumeration date
06/28/2017
Last updated
04/21/2021
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