Provider Demographics
NPI:1912066424
Name:MODERN DENTAL PROFESSIONALS UTAH PC
Entity type:Organization
Organization Name:MODERN DENTAL PROFESSIONALS UTAH PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAHOON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-220-0940
Mailing Address - Street 1:420 E SOUTH TEMPLE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1319
Mailing Address - Country:US
Mailing Address - Phone:801-220-0940
Mailing Address - Fax:
Practice Address - Street 1:420 E SOUTH TEMPLE
Practice Address - Street 2:SUITE 312
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1319
Practice Address - Country:US
Practice Address - Phone:801-220-0940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2025-01-06
Deactivation Date:2024-04-08
Deactivation Code:
Reactivation Date:2025-01-06
Provider Licenses
StateLicense IDTaxonomies
UT139914-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty