Provider Demographics
NPI:1700821089
Name:MACKAY DENTAL AND ASSOCIATES
Entity Type:Organization
Organization Name:MACKAY DENTAL AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNDON
Authorized Official - Middle Name:C
Authorized Official - Last Name:MACKAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-969-3025
Mailing Address - Street 1:3550 S 4800 W
Mailing Address - Street 2:SUITE J
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-2966
Mailing Address - Country:US
Mailing Address - Phone:801-969-3025
Mailing Address - Fax:801-969-6115
Practice Address - Street 1:3550 S 4800 W
Practice Address - Street 2:SUITE J
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2966
Practice Address - Country:US
Practice Address - Phone:801-969-3025
Practice Address - Fax:801-969-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1344431223G0001X
UT53316931223G0001X
UT59232411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529557774001Medicaid
UT83693OtherPEHP DR DEMILLE
UT1990OtherPEHP DR LYNDON MACKAY
UT529271638001Medicaid
UT529588149009Medicaid
UT73439OtherPEHP DR DAVID MACKAY