Provider Demographics
NPI:1891025219
Name:APEX FAMILY & COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:APEX FAMILY & COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-677-2739
Mailing Address - Street 1:1227 W 9000 S
Mailing Address - Street 2:SUITE E
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9001
Mailing Address - Country:US
Mailing Address - Phone:801-677-2739
Mailing Address - Fax:801-676-0840
Practice Address - Street 1:1227 W 9000 S
Practice Address - Street 2:SUITE E
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9001
Practice Address - Country:US
Practice Address - Phone:801-677-2739
Practice Address - Fax:801-676-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty