Amigos Dental Care- Marmalade District, LLC
Clinic/Center, Dental in Salt Lake City, UT. Organization (NPI-2).
NPI number1508435280
StatusActive
Last updated in NPPESJun 17, 2021
Details
- NPI
- 1508435280
- Entity type
- Organization (NPI-2)
- Legal business name
- Amigos Dental Care- Marmalade District, LLC
- Organization subpart
- No
- Enumeration date
- Jun 17, 2021
- Certification date
- Jun 17, 2021
- Last updated
- Jun 17, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Other names
- Marmalade Dentistry (Doing Business As)
Practice location
333 N 300 WSalt Lake City, UT 84103-1215
Phone 801-419-0304
Mailing address
333 N 300 WSalt Lake City, UT 84103-1215
Phone 801-419-0304
Authorized official
Benjamin Bowman
Owner/Partner
4053268004
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