Provider Demographics
NPI:1700287257
Name:ISMILE AT OGDEN DENTAL PLLC
Entity Type:Organization
Organization Name:ISMILE AT OGDEN DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:HINCKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-479-1181
Mailing Address - Street 1:5275 ADAMS AVE PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6748
Mailing Address - Country:US
Mailing Address - Phone:801-479-1181
Mailing Address - Fax:
Practice Address - Street 1:5275 ADAMS AVE PKWY STE A
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6748
Practice Address - Country:US
Practice Address - Phone:801-479-1181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ISMILE AT OGDEN DENTAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2683061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty