Provider Demographics
NPI:1669745477
Name:PLATINUM DENTAL CARE
Entity type:Organization
Organization Name:PLATINUM DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-655-3788
Mailing Address - Street 1:279 E 5900 S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-293-1234
Mailing Address - Fax:801-293-0287
Practice Address - Street 1:279 E 5900 S
Practice Address - Street 2:SUITE 200
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5421
Practice Address - Country:US
Practice Address - Phone:801-293-1234
Practice Address - Fax:801-293-0287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12604477-003-STC126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126800000XDental ProvidersDental AssistantGroup - Multi-Specialty