Provider Demographics
NPI:1598880783
Name:ROCK HOTEL DENTAL, LLC
Entity Type:Organization
Organization Name:ROCK HOTEL DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-779-1659
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:88 E STATE ST
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-0220
Mailing Address - Country:US
Mailing Address - Phone:801-451-2341
Mailing Address - Fax:
Practice Address - Street 1:88 E STATE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2343
Practice Address - Country:US
Practice Address - Phone:801-451-2341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty