Provider Demographics
NPI:1386048171
Name:RIVERTON HEIGHTS DENTAL CARE
Entity type:Organization
Organization Name:RIVERTON HEIGHTS DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BORG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-878-3111
Mailing Address - Street 1:3693 W 13400 S
Mailing Address - Street 2:SUITE B
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-6411
Mailing Address - Country:US
Mailing Address - Phone:801-878-3111
Mailing Address - Fax:801-878-3444
Practice Address - Street 1:3693 W 13400 S
Practice Address - Street 2:SUITE B
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-6411
Practice Address - Country:US
Practice Address - Phone:801-878-3111
Practice Address - Fax:801-878-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6227003-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty