Provider Demographics
NPI:1497164032
Name:WHITECAP INSTITIUTE
Entity Type:Organization
Organization Name:WHITECAP INSTITIUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RILEY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:435-657-1205
Mailing Address - Street 1:380 E 1500 S STE 205
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-3942
Mailing Address - Country:US
Mailing Address - Phone:435-657-2105
Mailing Address - Fax:435-709-3079
Practice Address - Street 1:380 E 1500 S STE 205
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3942
Practice Address - Country:US
Practice Address - Phone:435-657-2105
Practice Address - Fax:435-709-3079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9053425-8903302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization