Provider Demographics
NPI:1659652519
Name:INTERMOUNTAIN DENTURES PLLC
Entity Type:Organization
Organization Name:INTERMOUNTAIN DENTURES PLLC
Other - Org Name:SMILES RESTORED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-688-2772
Mailing Address - Street 1:437 S BLUFF ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3592
Mailing Address - Country:US
Mailing Address - Phone:435-688-2772
Mailing Address - Fax:435-688-2781
Practice Address - Street 1:437 S BLUFF ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3592
Practice Address - Country:US
Practice Address - Phone:435-688-2772
Practice Address - Fax:435-688-2781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT725113899211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty