Provider Demographics
NPI:1578878443
Name:MOUNTAIN VIEW PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:MOUNTAIN VIEW PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:QUAYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-737-5437
Mailing Address - Street 1:2719 N HIGHWAY 89
Mailing Address - Street 2:STE 200
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84404-6256
Mailing Address - Country:US
Mailing Address - Phone:801-737-5437
Mailing Address - Fax:801-737-5452
Practice Address - Street 1:2719 N HIGHWAY 89
Practice Address - Street 2:STE 200
Practice Address - City:PLEASANT VIEW
Practice Address - State:UT
Practice Address - Zip Code:84404-6256
Practice Address - Country:US
Practice Address - Phone:801-737-5437
Practice Address - Fax:801-737-5452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5776592-9923261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental