Provider Demographics
NPI:1073735619
Name:UTAH ORTHODONTIC CARE,P.C.
Entity Type:Organization
Organization Name:UTAH ORTHODONTIC CARE,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:RANDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-474-9552
Mailing Address - Street 1:1140 BRICKYARD RD
Mailing Address - Street 2:#32B
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2565
Mailing Address - Country:US
Mailing Address - Phone:801-474-9552
Mailing Address - Fax:801-474-9558
Practice Address - Street 1:1140 BRICKYARD RD
Practice Address - Street 2:#32B
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2565
Practice Address - Country:US
Practice Address - Phone:801-474-9552
Practice Address - Fax:801-474-9558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT346388-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty