| Signature Smiles Luxury Dental Spa | |
|
6183 S Prairie View Dr Suite 101 Salt Lake City UT 84129-3202 | |
| (801) 968-9147 | |
| (801) 966-2932 |
| Full Name | Signature Smiles Luxury Dental Spa |
|---|---|
| Speciality | Dentist |
| Location | 6183 S Prairie View Dr, Salt Lake City, Utah |
| Authorized Official Name and Position | Keith Victor Nelson (PRESIDENT) |
| Authorized Official Contact | 8019689147 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Signature Smiles Luxury Dental Spa 6183 S Prairie View Dr Ste 101 Salt Lake City UT 84129-3202 Ph: (801) 968-9147 | Signature Smiles Luxury Dental Spa 6183 S Prairie View Dr Suite 101 Salt Lake City UT 84129-3202 Ph: (801) 968-9147 |
| NPI Number | 1316169162 |
|---|---|
| Provider Enumeration Date | 05/02/2007 |
| Last Update Date | 07/17/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316169162 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 5032263 (Utah) | Primary |
| 122300000X | Dentist | 62277 (California) | Secondary |
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