Provider Demographics
NPI:1477649697
Name:WASATCH FAMILY DENTISTRY
Entity Type:Organization
Organization Name:WASATCH FAMILY DENTISTRY
Other - Org Name:BACK OF THE WASATCH FAMILY & COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:REED
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOBROT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-654-4500
Mailing Address - Street 1:380 E 1500 S
Mailing Address - Street 2:#203
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032
Mailing Address - Country:US
Mailing Address - Phone:435-654-4500
Mailing Address - Fax:435-654-3728
Practice Address - Street 1:380 E 1500 S
Practice Address - Street 2:#203
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032
Practice Address - Country:US
Practice Address - Phone:435-654-4500
Practice Address - Fax:435-654-3728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT373732-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty