Provider Demographics
NPI:1952794711
Name:RIVERTON SMILE CENTER
Entity Type:Organization
Organization Name:RIVERTON SMILE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-318-4572
Mailing Address - Street 1:2845 W 12600 S
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7147
Mailing Address - Country:US
Mailing Address - Phone:801-254-5255
Mailing Address - Fax:
Practice Address - Street 1:2845 W 12600 S
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7147
Practice Address - Country:US
Practice Address - Phone:801-254-5255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty