| The Center Of Dental Professionals | |
|
530 E 500 S Salt Lake City UT 84102 | |
| (801) 747-8000 | |
| (801) 747-8001 |
| Full Name | The Center Of Dental Professionals |
|---|---|
| Speciality | Dentist |
| Location | 530 E 500 S, Salt Lake City, Utah |
| Authorized Official Name and Position | Christie Marie Mccutchan (OWNER) |
| Authorized Official Contact | 8017478012 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Center Of Dental Professionals 530 E 500 S Salt Lake City UT 84102 Ph: (801) 747-8000 | The Center Of Dental Professionals 530 E 500 S Salt Lake City UT 84102 Ph: (801) 747-8000 |
| NPI Number | 1114190659 |
|---|---|
| Provider Enumeration Date | 04/04/2008 |
| Last Update Date | 07/24/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114190659 | NPI | - | NPPES |
| 022824566005 | Medicaid | UT | |
| 5295997150001 | Medicaid | UT | |
| 1114118601 | Medicaid | UT | |
| 278683018001 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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