Provider Demographics
NPI:1346723319
Name:MP DENTAL LLC
Entity Type:Organization
Organization Name:MP DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCKELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-374-2182
Mailing Address - Street 1:777 N 500 W #204
Mailing Address - Street 2:
Mailing Address - City:PROUD
Mailing Address - State:UT
Mailing Address - Zip Code:84601
Mailing Address - Country:US
Mailing Address - Phone:801-374-2182
Mailing Address - Fax:801-374-0130
Practice Address - Street 1:777 N. 500 W. #204
Practice Address - Street 2:
Practice Address - City:PROUD
Practice Address - State:UT
Practice Address - Zip Code:84601
Practice Address - Country:US
Practice Address - Phone:801-374-2182
Practice Address - Fax:801-374-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty