Organization
NINTH EAST DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAITH GASKINS (DIRECTOR OF CREDENTIALING)
(972) 869-3789
Entity
Organization
Contact information
Practice address
1234 N 900 E STE 100, PROVO, UT 84604-2726
(801) 854-9140
Mailing address
1234 N 900 E STE 100, PROVO, UT 84604-2726
(801) 854-9140
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/13/2021
Last updated
09/29/2022
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