Modern Dental Professionals Ut, PC

NPI #1265889166 in South Ogden, Utah

Provider Information

NPI Number: 1265889166
Entity Type: Organization
Organization Name: Modern Dental Professionals Ut, PC
Subpart: Yes (part of a larger organization)
Parent Organization: MODERN DENTAL PROFESSIONALS UT, PC
Primary Specialty: Dentist
Enumeration Date: May 20, 2016
Last Updated: Apr 8, 2024

Practice Location

Address: 5974 S. FASHION POINTE DRIVE
Address 2: SUITE 210
City: South Ogden
State: Utah
ZIP Code: 84403
Phone: (801) 475-6121

Authorized Official

Name: LILIANA MARTINEZ
Title: CREDENTIALING DIRECTOR
Phone: (493) 089-7929

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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