Provider Demographics
NPI:1952877813
Name:NEVILLE DENTAL CARE LLC
Entity Type:Organization
Organization Name:NEVILLE DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-543-2273
Mailing Address - Street 1:743 KING ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4679
Mailing Address - Country:US
Mailing Address - Phone:801-543-2273
Mailing Address - Fax:801-991-2993
Practice Address - Street 1:743 KING ST STE 300
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4679
Practice Address - Country:US
Practice Address - Phone:801-543-2273
Practice Address - Fax:801-991-2993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1223G0001XOther57433379922