WASATCH PERIODONTAL SPECIALISTS LLC NPI 1962162412

NPI Information

WASATCH PERIODONTAL SPECIALISTS LLC is a periodontics dentist in Salt Lake City, UT. The provider is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. WASATCH PERIODONTAL SPECIALISTS LLC NPI is 1962162412. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4252 S HIGHLAND DR STE 101
SALT LAKE CITY, UT
ZIP 84124-684
Phone: (801) 783-6249

The provider's authorized official is Daniel Thunell .
The authorized official title is Member and has the following contact phone number (801) 783-6249.

The CLIA number assigned to this NPI record is 46D2200864 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 12/26/2021 and was last updated on 12/26/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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