Provider Demographics
NPI:1497107213
Name:ON SITE DENTAL LLC
Entity Type:Organization
Organization Name:ON SITE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-731-4440
Mailing Address - Street 1:1812 N 2000 W
Mailing Address - Street 2:SUITE 8
Mailing Address - City:FARR WEST
Mailing Address - State:UT
Mailing Address - Zip Code:84404-8058
Mailing Address - Country:US
Mailing Address - Phone:801-731-4440
Mailing Address - Fax:801-731-4536
Practice Address - Street 1:1812 N 2000 W
Practice Address - Street 2:SUITE 8
Practice Address - City:FARR WEST
Practice Address - State:UT
Practice Address - Zip Code:84404-8058
Practice Address - Country:US
Practice Address - Phone:801-731-4440
Practice Address - Fax:801-731-4536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty