Organization
RED PINE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID JACKSON DDS (OWNER)
(801) 966-3166
Entity
Organization
Contact information
Practice address
3550 S 5600 W STE 3, WEST VALLEY, UT 84120-2778
(801) 966-3166
Mailing address
3550 S 5600 W STE 3, WEST VALLEY, UT 84120-2778
(801) 966-3166
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
04/05/2021
Last updated
04/05/2021
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