Organization
DELTA FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LEANN W CHURCH (OFFICE MANAGER)
(435) 864-2120
Entity
Organization
Contact information
Practice address
372 W MAIN ST, DELTA, UT 84624-9221
(435) 864-2120
(435) 864-4085
Mailing address
372 W MAIN ST, P.O. BOX 695, DELTA, UT 84624-9221
(435) 864-2120
(435) 864-4085
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
267126
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
166630
UNITED CONCORDIA
UT
05
—
528067372008
—
UT
01
—
52806737201001
BCBS
UT
01
—
870521915ST1
EDUCATORS MUTUAL
UT
01
—
94276
DELTA
UT
Enumeration date
04/16/2007
Last updated
08/22/2020
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