Provider Demographics
NPI:1407162878
Name:DAVID B PRINCE DDS PC
Entity Type:Organization
Organization Name:DAVID B PRINCE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BUTLER
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-222-0789
Mailing Address - Street 1:417 N OREM BLVD
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-8813
Mailing Address - Country:US
Mailing Address - Phone:801-222-0789
Mailing Address - Fax:801-222-9973
Practice Address - Street 1:417 N OREM BLVD
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-8813
Practice Address - Country:US
Practice Address - Phone:801-222-0789
Practice Address - Fax:801-222-9973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT359734-9921261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center