Provider Demographics
NPI:1932522208
Name:HALF DENTAL UTAH LLC
Entity type:Organization
Organization Name:HALF DENTAL UTAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-852-5252
Mailing Address - Street 1:2274 N 400 E
Mailing Address - Street 2:STE 202
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-7378
Mailing Address - Country:US
Mailing Address - Phone:801-852-5252
Mailing Address - Fax:801-855-7152
Practice Address - Street 1:2274 N 400 E
Practice Address - Street 2:STE 202
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-7378
Practice Address - Country:US
Practice Address - Phone:801-852-5252
Practice Address - Fax:801-855-7152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7403598-9922261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental