Provider Demographics
NPI:1932948825
Name:UTAH MOUNTAIN DENTAL PARTNERS PC
Entity type:Organization
Organization Name:UTAH MOUNTAIN DENTAL PARTNERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF INTEGRATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-234-8490
Mailing Address - Street 1:321 N MALL DR STE D101
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7321
Mailing Address - Country:US
Mailing Address - Phone:435-628-5496
Mailing Address - Fax:
Practice Address - Street 1:321 N MALL DR STE D101
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7321
Practice Address - Country:US
Practice Address - Phone:435-628-5496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIGNATURE DENTAL PARTNERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental