Intermountain Dental Associates -Periodontics
NPI #1093083990 in North Ogden, Utah
Provider Information
- NPI Number
- 1093083990
- Entity Type
- Organization
- Organization Name
- Intermountain Dental Associates -Periodontics
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- INTERMOUNTAIN DENTAL ASSOCIATES SPECIALTY
- Primary Specialty
- Dentist - Periodontics
- Enumeration Date
- Dec 6, 2011
- Last Updated
- Dec 6, 2011
Practice Location
- Address
- 2721 N 400 E
- Address 2
- SUITE 2
- City
- North Ogden
- State
- Utah
- ZIP Code
- 84414-2393
- Phone
- (801) 782-5682
Authorized Official
- Name
- VICKI LEWIS
- Title
- SPECIALIST COORDINATOR
- Phone
- (801) 782-5682
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - Periodontics — Periodontics |
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