Provider Demographics
NPI:1831721240
Name:SG DENTAL PLLC
Entity type:Organization
Organization Name:SG DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:GRUBER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:435-665-7730
Mailing Address - Street 1:3569 W 10305 S
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8213
Mailing Address - Country:US
Mailing Address - Phone:435-665-7730
Mailing Address - Fax:
Practice Address - Street 1:225 SKYHAWK DR
Practice Address - Street 2:
Practice Address - City:WENDOVER
Practice Address - State:UT
Practice Address - Zip Code:84083-4501
Practice Address - Country:US
Practice Address - Phone:801-718-6881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental