Provider Demographics
NPI:1457759425
Name:HULSE DENTISRY LLC
Entity Type:Organization
Organization Name:HULSE DENTISRY LLC
Other - Org Name:SALEM SMILES FAMILY DENTISRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WENNERHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-423-7969
Mailing Address - Street 1:601 N STATE ROAD 198
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-4504
Mailing Address - Country:US
Mailing Address - Phone:801-423-7969
Mailing Address - Fax:801-504-6158
Practice Address - Street 1:601 N STATE ROAD 198
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:UT
Practice Address - Zip Code:84653-4504
Practice Address - Country:US
Practice Address - Phone:801-423-7969
Practice Address - Fax:801-504-6158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental