Provider Demographics
NPI:1376088906
Name:3980 S 700 E DENTAL LLC
Entity Type:Organization
Organization Name:3980 S 700 E DENTAL LLC
Other - Org Name:SALT LAKE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALLIS
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:ZURCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-268-8053
Mailing Address - Street 1:3980 S 700 E STE 21
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2586
Mailing Address - Country:US
Mailing Address - Phone:801-550-5013
Mailing Address - Fax:801-268-3247
Practice Address - Street 1:622 E 4500 S
Practice Address - Street 2:STE 201
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-268-8053
Practice Address - Fax:801-268-3247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10042413-9921261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental