Provider Demographics
NPI:1164156907
Name:SERENE DENTISTRY OF NORTH SALT LAKE, PLLC
Entity Type:Organization
Organization Name:SERENE DENTISTRY OF NORTH SALT LAKE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-458-8720
Mailing Address - Street 1:761 N REDWOOD RD STE 120
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-2894
Mailing Address - Country:US
Mailing Address - Phone:385-300-8184
Mailing Address - Fax:385-489-7775
Practice Address - Street 1:761 N REDWOOD RD STE 120
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-2894
Practice Address - Country:US
Practice Address - Phone:385-300-8184
Practice Address - Fax:385-489-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-15
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental