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NPI Code Detail

MEDICARE: DR. CRAIG S CHURCH DDS

MEDICARE: DR. CRAIG S CHURCH DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry2754949922UT

General Provider Information

NPI Number : 1053400143
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CRAIG S CHURCH DDS
Provider Business Mailing Address
First Line : 85 N CENTER ST
Second Line :
City : DELTA
State : UT
Zip : 84624-8430
Country : US
Telephone Number : 435-864-4623
Fax Number :
Provider Business Practice Location Address
First Line : 85 N CENTER ST
Second Line :
City : DELTA
State : UT
Zip : 84624-8430
Country : US
Telephone Number : 435-864-4623
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 08/07/2014

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Directions to “ DR. CRAIG S CHURCH DDS” Practice Location

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