Provider Demographics
NPI:1730581919
Name:TRIPLE CROWN DENTAL PLLC
Entity type:Organization
Organization Name:TRIPLE CROWN DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAUREAN
Authorized Official - Middle Name:TRAVAS
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-310-8244
Mailing Address - Street 1:2725 EAST PARLEYS WAY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109
Mailing Address - Country:US
Mailing Address - Phone:801-875-0570
Mailing Address - Fax:801-657-3745
Practice Address - Street 1:2725 E PARLEYS WAY
Practice Address - Street 2:SUITE 150
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-1667
Practice Address - Country:US
Practice Address - Phone:801-875-0570
Practice Address - Fax:801-657-3745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9030705-8903261QD0000X
UT9030705-9922261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental