Provider Demographics
NPI:1285328013
Name:CC DENTAL PLLC
Entity type:Organization
Organization Name:CC DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-586-6541
Mailing Address - Street 1:1883 W ROYAL HUNTE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-4086
Mailing Address - Country:US
Mailing Address - Phone:435-586-6541
Mailing Address - Fax:435-304-6161
Practice Address - Street 1:1883 W ROYAL HUNTE DR STE 100
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-4086
Practice Address - Country:US
Practice Address - Phone:435-586-6541
Practice Address - Fax:435-304-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental