Provider Demographics
NPI:1558553776
Name:A.F. FAMILY DENTAL, INC.
Entity type:Organization
Organization Name:A.F. FAMILY DENTAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-756-0933
Mailing Address - Street 1:321 E 300 N
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-1790
Mailing Address - Country:US
Mailing Address - Phone:801-756-0933
Mailing Address - Fax:
Practice Address - Street 1:321 E 300 N
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-1790
Practice Address - Country:US
Practice Address - Phone:801-756-0933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT145854-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty