Provider Demographics
NPI:1306255252
Name:ALL AROUND DENTAL CARE, LC
Entity type:Organization
Organization Name:ALL AROUND DENTAL CARE, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-900-1299
Mailing Address - Street 1:110 S 100 W
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-2102
Mailing Address - Country:US
Mailing Address - Phone:801-465-4855
Mailing Address - Fax:801-465-9562
Practice Address - Street 1:110 S 100 W
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2102
Practice Address - Country:US
Practice Address - Phone:801-465-4855
Practice Address - Fax:801-465-9562
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALL AROUND DENTAL CARE, LC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-05
Last Update Date:2015-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT334005122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1619047578Medicaid
UT1912028077Medicaid
UT1134168495Medicaid
UT1336364629Medicaid
UT1801945092Medicaid