Provider Demographics
NPI:1043664709
Name:SOUTH HILLS ORTHODONTICS
Entity type:Organization
Organization Name:SOUTH HILLS ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:SKANCHY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:385-210-1111
Mailing Address - Street 1:4013 W 13400 S
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6410
Mailing Address - Country:US
Mailing Address - Phone:385-210-1111
Mailing Address - Fax:
Practice Address - Street 1:4013 W 13400 S
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-6410
Practice Address - Country:US
Practice Address - Phone:385-210-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT87026471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty