Provider Demographics
NPI:1215554167
Name:MVP DENTAL, PLLC
Entity Type:Organization
Organization Name:MVP DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUISTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-292-6819
Mailing Address - Street 1:625 E 500 S STE 203
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-3884
Mailing Address - Country:US
Mailing Address - Phone:801-292-6819
Mailing Address - Fax:801-298-8573
Practice Address - Street 1:1195 W PARK LN STE 100
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-3665
Practice Address - Country:US
Practice Address - Phone:801-682-5810
Practice Address - Fax:801-298-8573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty