Canyon Dental Group LLC
Dentist, General Practice in Ogden, UT. Organization (NPI-2).
NPI number1669887204
StatusActive
Last updated in NPPESJun 23, 2014
Details
- NPI
- 1669887204
- Entity type
- Organization (NPI-2)
- Legal business name
- Canyon Dental Group LLC
- Organization subpart
- No
- Enumeration date
- Jun 23, 2014
- Last updated
- Jun 23, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 140299 | UT | Yes |
Practice location
512 12th StOgden, UT 84404-5803
Phone 801-399-5831 · Fax 801-409-0134
Mailing address
512 12th StOgden, UT 84404-5803
Phone 801-399-5831 · Fax 801-409-0134
Authorized official
Bart Wilson Wolthuis
Dr.
8013995831
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