Provider Demographics
NPI:1780912147
Name:39TH & 13TH STREET DENTAL
Entity type:Organization
Organization Name:39TH & 13TH STREET DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PINEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-278-1333
Mailing Address - Street 1:1345 EAST 3900 SOUTH
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84124
Mailing Address - Country:US
Mailing Address - Phone:801-278-1333
Mailing Address - Fax:801-278-6500
Practice Address - Street 1:1345 E 3900 S
Practice Address - Street 2:SUITE 206
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84124-1474
Practice Address - Country:US
Practice Address - Phone:801-278-1333
Practice Address - Fax:801-278-6500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty