Central Fossa LLC

NPI #1225470909 in Sandy, Utah

Provider Information

NPI Number: 1225470909
Entity Type: Organization
Organization Name: Central Fossa LLC
Primary Specialty: Dentist
Enumeration Date: Jul 23, 2013
Last Updated: Jul 23, 2013

Practice Location

Address: 7369 CREEK ROAD
City: Sandy
State: Utah
ZIP Code: 84121
Phone: (801) 566-5577

Authorized Official

Name: AMY E. FLORANCE DETHORN, DMD
Title: OWNER
Phone: (801) 566-5577

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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