MEDICARE: SVEN LEE PEERY DMD

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	122300000X	Dentist	D-4816	ID
2	122300000X	Dentist	9037688-9922	UT

General Provider Information

NPI Number	:	1720496714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SVEN LEE PEERY DMD

Provider Business Mailing Address
First Line	:	517 W 100 N STE 210
Second Line	:
City	:	PROVIDENCE
State	:	UT
Zip	:	84332-9826
Country	:	US
Telephone Number	:	435-755-6061
Fax Number	:	435-994-8362

Provider Business Practice Location Address
First Line	:	1515 N 400 E
Second Line	:	SUITE 104
City	:	NORTH LOGAN
State	:	UT
Zip	:	84341-7561
Country	:	US
Telephone Number	:	435-755-6061
Fax Number	:	435-755-6091

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

Provider Enumeration Date	:	07/23/2014
Last Update Date	:	08/23/2022

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Directions to “ SVEN LEE PEERY DMD” Practice Location

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