NPI 1821428921

Wasatch Endodontics, PC

Organisation Exclusive Provider Organization Bountiful, UT

Practice location

Address: 185 S 400 E Suite 201, Bountiful, UT 84010-4801
Phone: (801) 298-1101
Fax: (801) 298-1104

Authorised official

Name: Brady J Olsen
Title: Owner
Phone: (801) 298-1101

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 7270739-9922 (UT)

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Registry record

NPI: 1821428921
Entity type: Organization
NPI issued: 26 Nov 2013
Record last updated: 26 Nov 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.