Provider Demographics
NPI:1003539768
Name:ZION DENTAL PDC PLLC
Entity Type:Organization
Organization Name:ZION DENTAL PDC PLLC
Other - Org Name:ZION DENTAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-305-3460
Mailing Address - Street 1:PO BOX 971131
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-1131
Mailing Address - Country:US
Mailing Address - Phone:435-635-4333
Mailing Address - Fax:435-635-4331
Practice Address - Street 1:82 S 700 W
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-2462
Practice Address - Country:US
Practice Address - Phone:435-635-4333
Practice Address - Fax:435-635-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-19
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental