Provider Demographics
NPI:1376656017
Name:SMILEWIDE DENTAL CARE PC
Entity Type:Organization
Organization Name:SMILEWIDE DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:THORNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-446-6889
Mailing Address - Street 1:5629 W. 13100 S.
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096
Mailing Address - Country:US
Mailing Address - Phone:801-446-6889
Mailing Address - Fax:801-446-6881
Practice Address - Street 1:5629 W. 13100 S.
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096
Practice Address - Country:US
Practice Address - Phone:801-446-6889
Practice Address - Fax:801-446-6881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT532352099221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty