Provider Demographics
NPI:1063742492
Name:APEX FAMILY & COSMETIC DENTISTRY
Entity type:Organization
Organization Name:APEX FAMILY & COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-748-0379
Mailing Address - Street 1:12391 S 4000 W
Mailing Address - Street 2:SUITE 206
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-7012
Mailing Address - Country:US
Mailing Address - Phone:801-748-0379
Mailing Address - Fax:801-542-8188
Practice Address - Street 1:12391 S 4000 W
Practice Address - Street 2:SUITE 206
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-7012
Practice Address - Country:US
Practice Address - Phone:801-748-0379
Practice Address - Fax:801-542-8188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty