Organization Name: | GRANGER PEDIATRIC DENTISTRY |
NPI Number: | 1154637825 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JASON J HORGESHEIMER (DR/OWNER) |
Mailing Address: | 3725 W 4100 S West Valley City |
State: | UT US |
Postal Code: | 841205530 |
Phone Number: | 8019698881 |
Fax Number: | 8019698889 |
NPI Enumeration Date: | 08/19/2010 |
NPI Last Update Date: | 08/19/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 360305-9923 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |