Provider Demographics
NPI:1902008048
Name:CRESCENT DENTAL, INC.
Entity Type:Organization
Organization Name:CRESCENT DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANEEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WINTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-957-0130
Mailing Address - Street 1:5547 SO. 4015 W.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84118-4408
Mailing Address - Country:US
Mailing Address - Phone:801-957-0130
Mailing Address - Fax:
Practice Address - Street 1:5547 SO. 4015 W.
Practice Address - Street 2:SUITE 2
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84118-4408
Practice Address - Country:US
Practice Address - Phone:801-957-0130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT44491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty