Utah Dental Providers
NPI #1104903152 in Salt Lake City, Utah
Provider Information
- NPI Number
- 1104903152
- Entity Type
- Organization
- Organization Name
- Utah Dental Providers
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Nov 1, 2006
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 1909 W 4700 S
- City
- Salt Lake City
- State
- Utah
- ZIP Code
- 84118-1105
- Phone
- (801) 968-9548
Authorized Official
- Name
- JOHN EVERETT BALLARD
- Title
- CIO
- Phone
- (972) 755-0800
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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