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Organization

CREEK ROAD ORTHODONTICS AND PEDIATRIC DENTISTRY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BARNEY TODD OLSEN D.D.S., M.S. (DENTIST/OWNER)
(801) 562-5505
Entity
Organization

Contact information

Practice address
7410 CREEK RD, SUITE #200, SANDY, UT 84093-6140
(801) 562-5505
Mailing address
7410 CREEK RD, SUITE #200, SANDY, UT 84093-6140
(801) 562-5505

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
76505
UT
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
76505
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
528962557001
UT
Enumeration date
11/17/2011
Last updated
11/17/2011
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