Provider Demographics
NPI:1992261143
Name:PARK CITY DENTAL ASSOCIATES LLC
Entity type:Organization
Organization Name:PARK CITY DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-671-7956
Mailing Address - Street 1:1830 PROSPECTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7319
Mailing Address - Country:US
Mailing Address - Phone:435-649-6066
Mailing Address - Fax:
Practice Address - Street 1:1830 PROSPECTOR AVE
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7319
Practice Address - Country:US
Practice Address - Phone:435-649-6066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARK CITY DENTAL ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental