Provider Demographics
NPI:1578385597
Name:MWH03 LLC
Entity type:Organization
Organization Name:MWH03 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:EMILIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-318-4422
Mailing Address - Street 1:3816 W 13400 S STE 200
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7888
Mailing Address - Country:US
Mailing Address - Phone:385-533-9393
Mailing Address - Fax:
Practice Address - Street 1:3816 W 13400 S STE 200
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7888
Practice Address - Country:US
Practice Address - Phone:385-533-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty