Provider Demographics
NPI:1235778960
Name:ABUNDANT DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:ABUNDANT DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OR A/R
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-467-2345
Mailing Address - Street 1:5688 W 7800 S STE 104
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-5404
Mailing Address - Country:US
Mailing Address - Phone:801-254-4454
Mailing Address - Fax:
Practice Address - Street 1:5688 W 7800 S STE 104
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-5404
Practice Address - Country:US
Practice Address - Phone:801-254-4454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABUNDANT DENTAL CARE OF WEST JORDAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-28
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty