NPI 1861715005

Fresh Start Dental Center

Organisation Exclusive Provider Organization Taylorsville, UT

Practice location

Address: 6287 S Redwood Rd, Taylorsville, UT 84123-6634
Phone: (801) 313-1144
Fax: (801) 313-1141

Authorised official

Name: Roger Whitehouse
Title: Ceo
Phone: (801) 598-3333

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 12752998-002 (UT)

Other Exclusive Provider Organization providers in Utah →

Registry record

NPI: 1861715005
Entity type: Organization
NPI issued: 2 Mar 2010
Record last updated: 2 Mar 2010

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.