| Wisdom Teeth Only | |
|
2230 N University Pkwy 8a Provo UT 84604-1509 | |
| (801) 370-0050 | |
| (801) 370-9635 |
| Full Name | Wisdom Teeth Only |
|---|---|
| Speciality | Dentist |
| Location | 2230 N University Pkwy, Provo, Utah |
| Authorized Official Name and Position | Heath Hendrickson (OWNER) |
| Authorized Official Contact | 8013700050 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wisdom Teeth Only 2230 N University Pkwy 8a Provo UT 84604-1509 Ph: (801) 370-0050 | Wisdom Teeth Only 2230 N University Pkwy 8a Provo UT 84604-1509 Ph: (801) 370-0050 |
| NPI Number | 1912212895 |
|---|---|
| Provider Enumeration Date | 08/16/2010 |
| Last Update Date | 08/16/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912212895 | NPI | - | NPPES |
| HT000004-001 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 51365979922 (Utah) | Primary |
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