Provider Demographics
NPI:1871345603
Name:EAST LAYTON DENTAL LLC
Entity type:Organization
Organization Name:EAST LAYTON DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:STREIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-547-8800
Mailing Address - Street 1:250 E GENTILE ST
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-3863
Mailing Address - Country:US
Mailing Address - Phone:801-547-8800
Mailing Address - Fax:
Practice Address - Street 1:250 E GENTILE ST
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-3863
Practice Address - Country:US
Practice Address - Phone:801-547-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty