Provider Demographics
NPI:1700039351
Name:ACCENT SMILES DENTAL CARE
Entity Type:Organization
Organization Name:ACCENT SMILES DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:T
Authorized Official - Last Name:BLACKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-274-2351
Mailing Address - Street 1:5738 S 1475 E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4858
Mailing Address - Country:US
Mailing Address - Phone:801-392-1500
Mailing Address - Fax:801-475-6558
Practice Address - Street 1:5738 S 1475 E
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4858
Practice Address - Country:US
Practice Address - Phone:801-392-1500
Practice Address - Fax:801-475-6558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT59363461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty