Provider Demographics
NPI:1508407230
Name:AA DENTAL LLP
Entity Type:Organization
Organization Name:AA DENTAL LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-796-3535
Mailing Address - Street 1:597 S PLEASANT GROVE BLVD STE 12
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3070
Mailing Address - Country:US
Mailing Address - Phone:801-796-3535
Mailing Address - Fax:801-796-0303
Practice Address - Street 1:597 S PLEASANT GROVE BLVD STE 12
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3070
Practice Address - Country:US
Practice Address - Phone:801-796-3535
Practice Address - Fax:801-796-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental