Provider Demographics
NPI:1710233887
Name:TMJ & SLEEP THERAPY CENTRE OF UTAH
Entity Type:Organization
Organization Name:TMJ & SLEEP THERAPY CENTRE OF UTAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-691-0457
Mailing Address - Street 1:812 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-7026
Mailing Address - Country:US
Mailing Address - Phone:801-691-0457
Mailing Address - Fax:801-691-1232
Practice Address - Street 1:812 S STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-7026
Practice Address - Country:US
Practice Address - Phone:801-691-0457
Practice Address - Fax:801-691-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-26
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT375815122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty