Provider Demographics
NPI:1013698927
Name:BSOMM DENTAL PLLC
Entity type:Organization
Organization Name:BSOMM DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE LEAD
Authorized Official - Prefix:
Authorized Official - First Name:TIANA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:ROPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-885-2334
Mailing Address - Street 1:5481 W 7800 S STE 150
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-6030
Mailing Address - Country:US
Mailing Address - Phone:801-885-2334
Mailing Address - Fax:
Practice Address - Street 1:5481 W 7800 S STE 150
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-6030
Practice Address - Country:US
Practice Address - Phone:801-885-2334
Practice Address - Fax:385-359-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty