Provider Demographics
NPI:1841475456
Name:HIDDEN VALLEY PEDIATRIC DENTAL INC
Entity type:Organization
Organization Name:HIDDEN VALLEY PEDIATRIC DENTAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:DEHART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-495-1610
Mailing Address - Street 1:114 E 12450 S STE 200
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8060
Mailing Address - Country:US
Mailing Address - Phone:801-495-1610
Mailing Address - Fax:801-495-1631
Practice Address - Street 1:114 E 12450 S STE 200
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8060
Practice Address - Country:US
Practice Address - Phone:801-495-1610
Practice Address - Fax:801-495-1631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical