Organization
INTERMOUNTAIN DENTAL SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VICKI LEWIS (SPECIALIST COORDINATOR)
(801) 782-5682
Entity
Organization
Contact information
Practice address
2797 N HIGHWAY 89, SUITE 200, PLEASANT VIEW, UT 84404-1216
(801) 782-5682
(801) 786-0520
Mailing address
2797 N HIGHWAY 89, SUITE 200, PLEASANT VIEW, UT 84404-1216
(801) 782-5682
(801) 786-0520
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
145288-9922
UT
1223E0200X
Endodontics
145326-9922
UT
1223P0300X
Periodontics
137712-9922
UT
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
8598613-9924
UT
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
8041458
UT
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
9371431-9921
UT
Other
Enumeration date
12/11/2015
Last updated
12/11/2015
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