Provider Demographics
NPI:1275999443
Name:TAYLORSVILLE EMERGENCY AND FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:TAYLORSVILLE EMERGENCY AND FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERNANDEZ-GIL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-769-4486
Mailing Address - Street 1:2852 W 4700 S
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-2100
Mailing Address - Country:US
Mailing Address - Phone:801-969-3752
Mailing Address - Fax:385-355-9182
Practice Address - Street 1:2852 W 4700 S
Practice Address - Street 2:SUITE B
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-2100
Practice Address - Country:US
Practice Address - Phone:801-969-3752
Practice Address - Fax:385-355-9182
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HERNANDEZ GIL HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-04
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8677334-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty