Organization
FALLING CREEK DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD M GOERCKERITZ (OWNER)
(801) 495-3567
Entity
Organization
Contact information
Practice address
112 E 12450 S STE 101, DRAPER, UT 84020-8057
(801) 495-3567
Mailing address
112 E 12450 S STE 101, DRAPER, UT 84020-8057
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7015094
UT
Other
Enumeration date
11/01/2016
Last updated
11/01/2016
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