MEDICARE: HEIDI LYNNE IONGI 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	7082	NV
2	122300000X	Dentist	11629594-9923	UT

General Provider Information

NPI Number	:	1760977326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI LYNNE IONGI DMD

Provider Business Mailing Address
First Line	:	1412 S 400 E
Second Line	:
City	:	KAYSVILLE
State	:	UT
Zip	:	84037-3013
Country	:	US
Telephone Number	:	307-696-9375
Fax Number	:

Provider Business Practice Location Address
First Line	:	1492 W ANTELOPE DR STE 201
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-1141
Country	:	US
Telephone Number	:	801-776-6566
Fax Number	:

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

Provider Enumeration Date	:	06/26/2018
Last Update Date	:	05/02/2023

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