Provider Demographics
NPI:1700295227
Name:ALL AROUND DENTAL CARE, LC
Entity type:Organization
Organization Name:ALL AROUND DENTAL CARE, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-900-1299
Mailing Address - Street 1:777 N 500 W
Mailing Address - Street 2:STE 106
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-1541
Mailing Address - Country:US
Mailing Address - Phone:801-356-8420
Mailing Address - Fax:801-356-8510
Practice Address - Street 1:777 N 500 W
Practice Address - Street 2:STE 106
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-1541
Practice Address - Country:US
Practice Address - Phone:801-356-8420
Practice Address - Fax:801-356-8510
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALL AROUND DENTAL CARE, LC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-08
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT334005122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871597138Medicaid
UT1134408156Medicaid
UT1467688564Medicaid
UT1780939348Medicaid
UT1801945092Medicaid