Organization
SALT LAKE IMPLANTS AND PERIODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK MANGELSON DDS (OWNER)
(801) 266-3519
Entity
Organization
Contact information
Practice address
4010 S 700 E STE 8, SALT LAKE CITY, UT 84107-2582
(801) 266-3519
Mailing address
4010 S 700 E STE 8, SALT LAKE CITY, UT 84107-2582
(801) 266-3519
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
05/20/2019
Last updated
05/20/2019
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