12465 S FORT ST DRAPER DENTAL LLC – NPI #1790593051
Clinic/Center

12465 S FORT ST DRAPER DENTAL LLC is an AHC clinic located in DRAPER, UT. NPPES has assigned the NPI number 1790593051 to 12465 S FORT ST DRAPER DENTAL LLC on December 19, 2024. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 261QD0000X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Dental

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for 12465 S FORT ST DRAPER DENTAL LLC below.

NPI Profile for
12465 S FORT ST DRAPER DENTAL LLC

NPI Number
1790593051
Enumeration Date

(more than a year ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
12465 S FORT ST DRAPER DENTAL LLC
Primary location
12465 S FORT ST STE 100
DRAPER, UT 84020-8354
Phone: (801) 576-1167 Fax:
Mailing address
3757 E HERMES DR
MILLCREEK, UT 84124-3337
Phone: (801) 550-5013 Fax:
Organization Subpart
No
Authorized Official
DALLIS ZURCHER
DOCTOR
Phone: (801) 550-5013
Updated
Certification Date
Dec 19, 2024

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QD0000X
- Clinic/Center / Dental (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.