Provider Demographics
NPI:1013192731
Name:DENALI DENTAL
Entity Type:Organization
Organization Name:DENALI DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-544-4204
Mailing Address - Street 1:47 CRESTWOOD RD
Mailing Address - Street 2:STE. #3
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1445
Mailing Address - Country:US
Mailing Address - Phone:801-544-4204
Mailing Address - Fax:801-546-6140
Practice Address - Street 1:47 CRESTWOOD RD
Practice Address - Street 2:STE. #3
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1445
Practice Address - Country:US
Practice Address - Phone:801-544-4204
Practice Address - Fax:801-546-6140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT322402-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty