Provider Demographics
NPI:1730667031
Name:HM SALT LAKE
Entity Type:Organization
Organization Name:HM SALT LAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:HEPWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-702-7478
Mailing Address - Street 1:7138 S HIGHLAND DR STE 214
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3783
Mailing Address - Country:US
Mailing Address - Phone:810-942-7770
Mailing Address - Fax:
Practice Address - Street 1:7138 S HIGHLAND DR STE 214
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-3783
Practice Address - Country:US
Practice Address - Phone:810-942-7770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT94365969922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty