Provider Demographics
NPI:1588334387
Name:SALT LAKE MOBILE DENTAL LLC
Entity type:Organization
Organization Name:SALT LAKE MOBILE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DALLIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZURCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-550-5013
Mailing Address - Street 1:6315 S COBBLECREST RD
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2254
Mailing Address - Country:US
Mailing Address - Phone:801-550-5013
Mailing Address - Fax:
Practice Address - Street 1:622 E 4500 S STE 201
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-2922
Practice Address - Country:US
Practice Address - Phone:801-477-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental