Provider Demographics
NPI:1780157388
Name:CFDENTAL SPANISH FORK PLLC
Entity type:Organization
Organization Name:CFDENTAL SPANISH FORK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WINWARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-538-2213
Mailing Address - Street 1:822 TURF FARM RD
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-5709
Mailing Address - Country:US
Mailing Address - Phone:801-465-4490
Mailing Address - Fax:
Practice Address - Street 1:1265 NORTH CANYON CREEK PARKWAY
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660
Practice Address - Country:US
Practice Address - Phone:801-465-4490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty