Provider Demographics
NPI:1760595706
Name:ROCKY MOUNTAIN DENTAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:ALBERTELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-295-7171
Mailing Address - Street 1:1480 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5108
Mailing Address - Country:US
Mailing Address - Phone:801-295-7171
Mailing Address - Fax:
Practice Address - Street 1:1480 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5108
Practice Address - Country:US
Practice Address - Phone:801-295-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4964666-9922261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental