Provider Demographics
NPI:1649939232
Name:SALT FALTS DENTISTRY
Entity type:Organization
Organization Name:SALT FALTS DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-766-1717
Mailing Address - Street 1:5069 W 13400 S STE 200
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6602
Mailing Address - Country:US
Mailing Address - Phone:385-766-1717
Mailing Address - Fax:385-393-1315
Practice Address - Street 1:5069 W 13400 S STE 200
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-6602
Practice Address - Country:US
Practice Address - Phone:385-766-1717
Practice Address - Fax:385-393-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-11
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty