Organization
MSG DENTAL LLC
Active
Other names
Cougar Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TODD C GROESBECK DMD (DENTIST)
(801) 373-7700
Entity
Organization
Contact information
Practice address
835 N 700 E, PROVO, UT 84606-6993
(801) 373-7700
Mailing address
835 N 700 E, PROVO, UT 84606-6993
(801) 373-7700
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8372408-9922
UT
Other
Enumeration date
10/14/2016
Last updated
10/14/2016
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