Provider Demographics
NPI:1053158600
Name:UTAH DENTAL HEALTH PROFESSIONALS, P.C.
Entity type:Organization
Organization Name:UTAH DENTAL HEALTH PROFESSIONALS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:
Authorized Official - Last Name:THULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8946
Mailing Address - Street 1:14723 S MARKETPLACE DR
Mailing Address - Street 2:STE B
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-3361
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14723 S MARKETPLACE DR
Practice Address - Street 2:STE B
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-3361
Practice Address - Country:US
Practice Address - Phone:385-340-7505
Practice Address - Fax:385-340-7487
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty