Provider Demographics
NPI:1598999427
Name:39TH STREET DENTAL
Entity Type:Organization
Organization Name:39TH STREET DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PINEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-272-1199
Mailing Address - Street 1:1377 E 3900 S STE 101
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1489
Mailing Address - Country:US
Mailing Address - Phone:801-272-1199
Mailing Address - Fax:801-272-4639
Practice Address - Street 1:1377 E 3900 S STE 101
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1489
Practice Address - Country:US
Practice Address - Phone:801-272-1199
Practice Address - Fax:801-272-4639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1417061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty