Provider Demographics
NPI:1447922158
Name:PREMIER ORTHODONTIC CARE
Entity type:Organization
Organization Name:PREMIER ORTHODONTIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:801-997-5729
Mailing Address - Street 1:5502 W 13400 S STE A
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-5636
Mailing Address - Country:US
Mailing Address - Phone:801-997-5729
Mailing Address - Fax:
Practice Address - Street 1:5502 W 13400 S STE A
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-5636
Practice Address - Country:US
Practice Address - Phone:801-997-5729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER ORTHODONTIC CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty