Park City Pdc PLLC
Clinic/Center, Dental in Park City, UT. Organization (NPI-2).
NPI number1669909511
StatusActive
Last updated in NPPESJul 2, 2021
Details
- NPI
- 1669909511
- Entity type
- Organization (NPI-2)
- Legal business name
- Park City Pdc PLLC
- Organization subpart
- No
- Enumeration date
- May 22, 2017
- Certification date
- Jul 2, 2021
- Last updated
- Jul 2, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | 352590747 | UT | Yes |
Other names
- Snow Country Dental Care (Doing Business As)
Practice location
1729 Sidewinder Dr.Ste 102
Park City, UT 84060-7518
Phone 435-649-9492 · Fax 801-692-9083
Mailing address
Po Box 970309Orem, UT 84097-0309
Phone 801-691-1701 · Fax 801-335-6551
Authorized official
Jacob Warner
Credentialing Manager
8016911701
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All 6 Dental Clinic/Center providers in Park City · All 891 providers in Park City
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