Modern Dental Professionals - Utah, PC

NPI #1720485709 in West Valley, Utah

Provider Information

NPI Number: 1720485709
Entity Type: Organization
Organization Name: Modern Dental Professionals - Utah, PC
Primary Specialty: Dentist
Enumeration Date: Nov 19, 2014
Last Updated: Apr 8, 2024

Practice Location

Address: 4645 S 4000 W STE B
City: West Valley
State: Utah
ZIP Code: 84120-6250
Phone: (801) 955-1900

Authorized Official

Name: LILIANA MARTINEZ
Title: CREDENTIALING DIRECTOR
Phone: (949) 308-9792

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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