Provider Demographics
NPI:1376845610
Name:ALCORN FAMILY DENTISTRY
Entity Type:Organization
Organization Name:ALCORN FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALCORN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-492-0055
Mailing Address - Street 1:5455 W. 11000 NO.
Mailing Address - Street 2:#103
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003
Mailing Address - Country:US
Mailing Address - Phone:801-492-0055
Mailing Address - Fax:801-877-4355
Practice Address - Street 1:5455 W. 11000 NO.
Practice Address - Street 2:#103
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003
Practice Address - Country:US
Practice Address - Phone:801-492-0055
Practice Address - Fax:801-877-4355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT53298821223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty