| Pony Express Dental Of Draper, Llc | |
|
219 E 12300 S Suite I-5 Draper UT 84020-6970 | |
| (801) 495-4440 | |
| (801) 495-4442 |
| Full Name | Pony Express Dental Of Draper, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 219 E 12300 S, Draper, Utah |
| Authorized Official Name and Position | Michael S Tornow (DENTIST OWNER) |
| Authorized Official Contact | 5059474253 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pony Express Dental Of Draper, Llc 219 E 12300 S Suite I-5 Draper UT 84020-6970 Ph: (801) 495-4440 | Pony Express Dental Of Draper, Llc 219 E 12300 S Suite I-5 Draper UT 84020-6970 Ph: (801) 495-4440 |
| NPI Number | 1306380084 |
|---|---|
| Provider Enumeration Date | 12/14/2016 |
| Last Update Date | 12/14/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306380084 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 5015649-9923 (Utah) | Primary |
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