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Periodontics

NPI: 1447882303Individual

Specialties, Licenses & Credentials

General Practice Dentistry

Dentist — General Practice

Code: 1223G0001X

9712(SC)
Student in an Organized Health Care Education/Training Program

Student in an Organized Health Care Education/Training Program

Code: 390200000X

PeriodonticsPrimary

Dentist — Periodontics

Code: 1223P0300X

132148909924(UT)
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Contact & Hours

Address
77 S 700 E STE 260
SALT LAKE CITY, UT 84102

Quick Facts

NPI
1447882303
Entity Type
Individual
Gender
Male
Medicare
Not confirmed
Specialties
3
Locations
1

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