State of Utah, Department of Health
NPI #1437252491 in Salt Lake City, Utah
Provider Information
- NPI Number
- 1437252491
- Entity Type
- Organization
- Organization Name
- State of Utah, Department of Health
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Sep 6, 2006
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- SALT LAKE CLINIC - FAMILY DENTAL PLAN
- Address 2
- 3195 SOUTH MAIN STREET, SUITE 200
- City
- Salt Lake City
- State
- Utah
- ZIP Code
- 84114
- Phone
- (801) 468-0342
Authorized Official
- Name
- DR. DAVID SUNDWALL, M.D.
- Title
- EXECUTIVE DIRECTOR
- Phone
- (801) 538-6111
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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