MEDICARE: DR. BRADEN CORDELL ATKINS D.M.D.

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
1	1223P0300X	Periodontics	9017911-9924	UT

General Provider Information

NPI Number	:	1093093312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADEN CORDELL ATKINS D.M.D.

Provider Business Mailing Address
First Line	:	617 W 1825 N
Second Line	:
City	:	CENTERVILLE
State	:	UT
Zip	:	84014-3148
Country	:	US
Telephone Number	:	801-201-7429
Fax Number	:

Provider Business Practice Location Address
First Line	:	4645 S 4000 W STE B
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-6250
Country	:	US
Telephone Number	:	216-264-6804
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2011
Last Update Date	:	04/05/2021

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