Provider Demographics
NPI:1295887073
Name:VIP TOOTH CARE CENTER LLC
Entity type:Organization
Organization Name:VIP TOOTH CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:CLIVE
Authorized Official - Middle Name:C
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-776-3000
Mailing Address - Street 1:780 S 2000 W
Mailing Address - Street 2:STE F1
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-9602
Mailing Address - Country:US
Mailing Address - Phone:801-776-3000
Mailing Address - Fax:801-825-7700
Practice Address - Street 1:780 S 2000 W
Practice Address - Street 2:STE F1
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-9602
Practice Address - Country:US
Practice Address - Phone:801-776-3000
Practice Address - Fax:801-825-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty