Provider Demographics
NPI:1295424232
Name:CDA PRACTICE LLC
Entity type:Organization
Organization Name:CDA PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-755-9243
Mailing Address - Street 1:11978 S 700 E STE 101
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9818
Mailing Address - Country:US
Mailing Address - Phone:801-352-7002
Mailing Address - Fax:
Practice Address - Street 1:11978 S 700 E STE 101
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9818
Practice Address - Country:US
Practice Address - Phone:801-352-7002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental