Provider Demographics
NPI:1851552525
Name:MICHAEL E. FLORENCE DMD LLC
Entity Type:Organization
Organization Name:MICHAEL E. FLORENCE DMD LLC
Other - Org Name:PLEASANT VALLEY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:FLORENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-621-3383
Mailing Address - Street 1:5742 ADAMS AVE PKWY
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-7157
Mailing Address - Country:US
Mailing Address - Phone:801-621-3383
Mailing Address - Fax:801-334-7432
Practice Address - Street 1:5742 ADAMS AVE PKWY
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-7157
Practice Address - Country:US
Practice Address - Phone:801-621-3383
Practice Address - Fax:801-334-7432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2948981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty