Provider Demographics
NPI:1467744029
Name:FORT UNION FAMILY DENTAL, P.C
Entity Type:Organization
Organization Name:FORT UNION FAMILY DENTAL, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:ABRAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-562-2147
Mailing Address - Street 1:942 E 7145 S
Mailing Address - Street 2:SUITE A108
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1764
Mailing Address - Country:US
Mailing Address - Phone:801-562-2147
Mailing Address - Fax:801-569-1795
Practice Address - Street 1:942 E 7145 S
Practice Address - Street 2:SUITE A108
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1764
Practice Address - Country:US
Practice Address - Phone:801-562-2147
Practice Address - Fax:801-569-1795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49206931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty