Provider Demographics
NPI:1477917458
Name:ORAL DESIGN DENTAL
Entity Type:Organization
Organization Name:ORAL DESIGN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:OGANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-733-7035
Mailing Address - Street 1:4802 S HOLLADAY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5407
Mailing Address - Country:US
Mailing Address - Phone:801-733-7035
Mailing Address - Fax:801-733-7031
Practice Address - Street 1:4802 S HOLLADAY BLVD
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-5407
Practice Address - Country:US
Practice Address - Phone:801-733-7035
Practice Address - Fax:801-733-7031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty