| Professional Dental Llc | |
|
78 E 100 S Payson UT 84651-2262 | |
| (801) 465-0550 | |
| (801) 465-9475 |
| Full Name | Professional Dental Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 78 E 100 S, Payson, Utah |
| Authorized Official Name and Position | Robert D Hack (OWNER) |
| Authorized Official Contact | 8017858000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Dental Llc Po Box 1715 Orem UT 84059-1715 Ph: (801) 785-8000 | Professional Dental Llc 78 E 100 S Payson UT 84651-2262 Ph: (801) 465-0550 |
| NPI Number | 1457476376 |
|---|---|
| Provider Enumeration Date | 03/20/2007 |
| Last Update Date | 03/10/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457476376 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 56928280160 (Utah) | Primary |
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