Stansbury Dental and Implant Center Pdc Pllc

NPI #1013358449 in Stansbury Park, Utah

Provider Information

NPI Number: 1013358449
Entity Type: Organization
Organization Name: Stansbury Dental and Implant Center Pdc Pllc
Primary Specialty: Dentist
Enumeration Date: Jul 15, 2013
Last Updated: Dec 19, 2019

Practice Location

Address: 263 COUNTRY CLUB DR.
Address 2: SUITE 103
City: Stansbury Park
State: Utah
ZIP Code: 84074-9600
Phone: (432) 882-2850

Authorized Official

Name: JACOB WARNER
Title: CREDENTIALING MANAGER
Phone: (801) 691-1701

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary
Dentist - Periodontics — Periodontics	1223P0300X
Dentist - Orthodontics and Dentofacial Orthopedics — Orthodontics and Dentofacial Orthopedics	1223X0400X

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