Provider Demographics
NPI:1457548687
Name:A KID'S PLACE DENTISTRY INC.
Entity Type:Organization
Organization Name:A KID'S PLACE DENTISTRY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUTCHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-262-0807
Mailing Address - Street 1:292 E 3900 S
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-1557
Mailing Address - Country:US
Mailing Address - Phone:801-262-0807
Mailing Address - Fax:801-261-7459
Practice Address - Street 1:292 E 3900 S
Practice Address - Street 2:SUITE 7
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-1557
Practice Address - Country:US
Practice Address - Phone:801-262-0807
Practice Address - Fax:801-261-7459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty