College Dental Clinic LLC

NPI #1720465875 in Orem, Utah

Provider Information

NPI Number: 1720465875
Entity Type: Organization
Organization Name: College Dental Clinic LLC
Primary Specialty: Clinic/Center - Dental
Enumeration Date: Apr 28, 2015
Last Updated: Apr 28, 2015

Practice Location

Address: 1176 S 1480 W
City: Orem
State: Utah
ZIP Code: 84058-4905
Phone: (801) 426-0774

Authorized Official

Name: KENNETH MOLEN, DDS
Title: OWNER
Phone: (801) 426-0774

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X	Primary

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