Provider Demographics
NPI:1679957567
Name:PDC LAYTON LLC
Entity Type:Organization
Organization Name:PDC LAYTON LLC
Other - Org Name:PLATINUM DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAELOR
Authorized Official - Middle Name:
Authorized Official - Last Name:JEPPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-305-3460
Mailing Address - Street 1:2152 N HILL FIELD RD
Mailing Address - Street 2:STE 2
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4728
Mailing Address - Country:US
Mailing Address - Phone:801-776-3300
Mailing Address - Fax:
Practice Address - Street 1:2152 N HILL FIELD RD
Practice Address - Street 2:STE 2
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4728
Practice Address - Country:US
Practice Address - Phone:801-776-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6686816-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty