Provider Demographics
NPI:1497061162
Name:MAPLE MOUNTAIN DENTAL PLLC DBA MAPLE MOUNTAIN DENTISTRY
Entity Type:Organization
Organization Name:MAPLE MOUNTAIN DENTAL PLLC DBA MAPLE MOUNTAIN DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTMORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-491-8191
Mailing Address - Street 1:425 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-3410
Mailing Address - Country:US
Mailing Address - Phone:801-491-8191
Mailing Address - Fax:801-491-4912
Practice Address - Street 1:425 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:UT
Practice Address - Zip Code:84664-3410
Practice Address - Country:US
Practice Address - Phone:801-491-8191
Practice Address - Fax:801-491-4912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty