Provider Demographics
NPI:1750836839
Name:SEVIER VALLEY DENTAL
Entity Type:Organization
Organization Name:SEVIER VALLEY DENTAL
Other - Org Name:FOREVER YOUNG DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-893-2190
Mailing Address - Street 1:46 W 100 N
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-2530
Mailing Address - Country:US
Mailing Address - Phone:435-893-2190
Mailing Address - Fax:435-893-2191
Practice Address - Street 1:46 W 100 N
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-2530
Practice Address - Country:US
Practice Address - Phone:435-893-2190
Practice Address - Fax:435-893-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT322871-9923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty