Organization
PROFESSIONAL DENTAL RIVERTON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT D HACK (OWNER)
(801) 636-0110
Entity
Organization
Contact information
Practice address
13686 S REDWOOD RD STE C, RIVERTON, UT 84065-5907
(801) 446-8100
(801) 785-4030
Mailing address
PO BOX 1806, OREM, UT 84059-1806
(801) 785-8000
(801) 785-4030
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
—
—
124Q00000X
Dental Hygienist
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
10/18/2023
Last updated
10/18/2023
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