Provider Demographics
NPI:1790293454
Name:TREEHOUSE DENTAL INC
Entity Type:Organization
Organization Name:TREEHOUSE DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-830-3840
Mailing Address - Street 1:2188 S 650 E
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-6274
Mailing Address - Country:US
Mailing Address - Phone:801-979-2202
Mailing Address - Fax:
Practice Address - Street 1:11055 N ALPINE HWY
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-8924
Practice Address - Country:US
Practice Address - Phone:801-979-2202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty