Provider Demographics
NPI:1598881906
Name:EPHRAIM FAMILY DENTAL CLINIC, INC.
Entity Type:Organization
Organization Name:EPHRAIM FAMILY DENTAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:435-283-4081
Mailing Address - Street 1:35 E 400 S
Mailing Address - Street 2:
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627-1336
Mailing Address - Country:US
Mailing Address - Phone:435-283-4081
Mailing Address - Fax:435-283-6151
Practice Address - Street 1:35 E 400 S
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627-1336
Practice Address - Country:US
Practice Address - Phone:435-283-4081
Practice Address - Fax:435-283-6151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5684051-9922261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental