Provider Demographics
NPI:1578993275
Name:MATTHEW AND DAVID DENTAL PLLC
Entity Type:Organization
Organization Name:MATTHEW AND DAVID DENTAL PLLC
Other - Org Name:FOOTHILL DENTAL LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:STOHL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-582-5787
Mailing Address - Street 1:1355 FOOTHILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108
Mailing Address - Country:US
Mailing Address - Phone:801-582-5787
Mailing Address - Fax:801-582-4502
Practice Address - Street 1:1355 FOOTHILL DRIVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108
Practice Address - Country:US
Practice Address - Phone:801-582-5787
Practice Address - Fax:801-582-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT993737871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty