Provider Demographics
NPI:1992009799
Name:SLEEP AND LUNG CLINIC OF UTAH, INC.
Entity Type:Organization
Organization Name:SLEEP AND LUNG CLINIC OF UTAH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIENHART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-260-5864
Mailing Address - Street 1:5801 FASHION BLVD
Mailing Address - Street 2:STE. 280
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6159
Mailing Address - Country:US
Mailing Address - Phone:801-260-5864
Mailing Address - Fax:801-260-5865
Practice Address - Street 1:5801 S. FASHION BLVD
Practice Address - Street 2:STE. 280
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6159
Practice Address - Country:US
Practice Address - Phone:801-260-5864
Practice Address - Fax:801-260-5865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT207RP1001X
UT277542-1205207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty