Provider Demographics
NPI:1992306922
Name:SOUTH OGDEN SMILES, PC
Entity type:Organization
Organization Name:SOUTH OGDEN SMILES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:MCNEAL
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-389-0053
Mailing Address - Street 1:5856 HARRISON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2117
Mailing Address - Country:US
Mailing Address - Phone:801-475-7776
Mailing Address - Fax:801-475-7776
Practice Address - Street 1:5856 HARRISON BLVD STE B
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2117
Practice Address - Country:US
Practice Address - Phone:801-475-7776
Practice Address - Fax:801-475-5865
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH OGDEN SMILES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty