| NPI | 1578943163 |
|---|---|
| Doing Business As | KAYSVILLE PEDIATRIC DENTAL |
| Entity Type | Organization |
| Authorized Contact | MICHAEL BRANDON JONES Dentist/Owner 801-544-3323 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 6509903-9923) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 8173986) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 6509903-9923) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 8173986) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 6509903-9923) | |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2017-04-06 |