Provider Demographics
NPI:1154737427
Name:SANDY SHORES PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:SANDY SHORES PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:BEKKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-571-5800
Mailing Address - Street 1:1434 E. 9400 S. #205
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092
Mailing Address - Country:US
Mailing Address - Phone:801-571-5800
Mailing Address - Fax:801-571-5522
Practice Address - Street 1:1434 E. 9400 S. #205
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092
Practice Address - Country:US
Practice Address - Phone:801-571-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT142542122300000X
UT8320347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty