Provider Demographics
NPI:1851758320
Name:UC DENTAL CENTER, PLLC
Entity Type:Organization
Organization Name:UC DENTAL CENTER, PLLC
Other - Org Name:THE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:801-224-6165
Mailing Address - Street 1:1344 S 800 E
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-7781
Mailing Address - Country:US
Mailing Address - Phone:801-224-6165
Mailing Address - Fax:
Practice Address - Street 1:1344 S 800 E
Practice Address - Street 2:SUITE 220
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-7781
Practice Address - Country:US
Practice Address - Phone:801-224-6165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT51456591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty