Provider Demographics
NPI:1649062456
Name:PARK CITY ENDODONTICS LLC
Entity type:Organization
Organization Name:PARK CITY ENDODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:POGUE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-652-3700
Mailing Address - Street 1:2750 RASMUSSEN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5531
Mailing Address - Country:US
Mailing Address - Phone:435-645-7668
Mailing Address - Fax:
Practice Address - Street 1:2750 RASMUSSEN RD STE 102
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-5531
Practice Address - Country:US
Practice Address - Phone:435-645-7668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty