Provider Demographics
NPI:1376101436
Name:TELEDENTISTRY CONSULTING LLC
Entity Type:Organization
Organization Name:TELEDENTISTRY CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:866-272-5044
Mailing Address - Street 1:6695 S 1300 E
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-2716
Mailing Address - Country:US
Mailing Address - Phone:866-272-5044
Mailing Address - Fax:
Practice Address - Street 1:6695 S 1300 E
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-2716
Practice Address - Country:US
Practice Address - Phone:866-272-5044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental