| Pediatric Dental & Orthodontics Pc | |
|
3485 W 4800 S Roy UT 84067-9429 | |
| (801) 774-5437 | |
| (801) 774-9440 |
| Full Name | Pediatric Dental & Orthodontics Pc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 3485 W 4800 S, Roy, Utah |
| Authorized Official Name and Position | John R. Anderson (OWNER) |
| Authorized Official Contact | 8015405081 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dental & Orthodontics Pc 3485 W 4800 S Roy UT 84067-9429 Ph: (801) 774-5437 | Pediatric Dental & Orthodontics Pc 3485 W 4800 S Roy UT 84067-9429 Ph: (801) 774-5437 |
| NPI Number | 1184706491 |
|---|---|
| Provider Enumeration Date | 10/19/2006 |
| Last Update Date | 12/20/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184706491 | NPI | - | NPPES |
| 528537398001 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 341292 (Utah) | Primary |
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