Provider Demographics
NPI:1407961055
Name:WEST VALLEY DENTAL GROUP INC
Entity Type:Organization
Organization Name:WEST VALLEY DENTAL GROUP INC
Other - Org Name:MTN VIEW DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:O
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MAGD
Authorized Official - Phone:801-969-8200
Mailing Address - Street 1:6783 REDWOOD RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-2404
Mailing Address - Country:US
Mailing Address - Phone:801-969-8200
Mailing Address - Fax:801-261-8280
Practice Address - Street 1:6783 REDWOOD RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-2404
Practice Address - Country:US
Practice Address - Phone:801-969-8200
Practice Address - Fax:801-261-8280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1305191223G0001X, 1223X0400X
UT1356111223G0001X
UT1428631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty