Provider Demographics
NPI:1326285891
Name:SEALANTS FOR SMILES
Entity Type:Organization
Organization Name:SEALANTS FOR SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:J
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS, MBA
Authorized Official - Phone:801-313-7051
Mailing Address - Street 1:5373 GREEN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-4680
Mailing Address - Country:US
Mailing Address - Phone:801-313-7051
Mailing Address - Fax:801-290-5126
Practice Address - Street 1:5373 GREEN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84123-4680
Practice Address - Country:US
Practice Address - Phone:801-313-7051
Practice Address - Fax:801-290-5126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT140656-9924122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty