Provider Demographics
NPI:1982142824
Name:BLUFFDALE DENTAL
Entity Type:Organization
Organization Name:BLUFFDALE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BABCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-254-2626
Mailing Address - Street 1:14100 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BLUFFDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84065-5204
Mailing Address - Country:US
Mailing Address - Phone:801-254-2626
Mailing Address - Fax:801-849-1444
Practice Address - Street 1:14100 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:BLUFFDALE
Practice Address - State:UT
Practice Address - Zip Code:84065-5204
Practice Address - Country:US
Practice Address - Phone:801-254-2626
Practice Address - Fax:801-849-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5483941302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization