Provider Demographics
NPI:1568504181
Name:MOUNTAIN VIEW DENTAL GROUP LLC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:CALLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-465-3691
Mailing Address - Street 1:1172 E 100 N
Mailing Address - Street 2:SUITE #6
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-1667
Mailing Address - Country:US
Mailing Address - Phone:801-468-3691
Mailing Address - Fax:
Practice Address - Street 1:1172 E 100 N
Practice Address - Street 2:SUITE #6
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1667
Practice Address - Country:US
Practice Address - Phone:801-468-3691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6443840001Medicare NSC