Provider Demographics
NPI:1114371804
Name:SOUTH HILLS PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:SOUTH HILLS PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BARTON
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:385-210-1000
Mailing Address - Street 1:4013 W 13400 S
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6410
Mailing Address - Country:US
Mailing Address - Phone:385-210-1000
Mailing Address - Fax:
Practice Address - Street 1:4013 W 13400 S
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-6410
Practice Address - Country:US
Practice Address - Phone:385-210-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT96759619923261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental