Organization
DENTISTRY FOR CHILDREN WEST VALLEY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY L DAVILA (OFFICE MANAGER)
(801) 955-5200
Entity
Organization
Contact information
Practice address
3540 S 4000 W STE 440, WEST VALLEY, UT 84120-3295
(801) 955-5200
(801) 955-1707
Mailing address
3540 S 4000 W STE 440, WEST VALLEY, UT 84120-3295
(801) 955-5200
(801) 955-1707
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
5247754
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529313580001
—
UT
Enumeration date
10/27/2010
Last updated
10/27/2010
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