Provider Demographics
NPI:1477696235
Name:WOODLAND PARK DENTAL P.C.
Entity Type:Organization
Organization Name:WOODLAND PARK DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAESAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:HEARNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-728-4688
Mailing Address - Street 1:880 HERITAGE PARK BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5676
Mailing Address - Country:US
Mailing Address - Phone:801-728-4688
Mailing Address - Fax:801-728-4868
Practice Address - Street 1:880 HERITAGE PARK BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5676
Practice Address - Country:US
Practice Address - Phone:801-728-4688
Practice Address - Fax:801-728-4868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT358446-99231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty