Healthcare Provider Details

I. General information

NPI: 1073531323
Provider Name (Legal Business Name): STEVEN REED BRAITHWAITE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 N WEST STATE RD
AMERICAN FORK UT
84003-1419
US

IV. Provider business mailing address

218 N WEST STATE RD
AMERICAN FORK UT
84003-1419
US

V. Phone/Fax

Practice location:
  • Phone: 801-763-7737
  • Fax: 801-763-7757
Mailing address:
  • Phone: 801-763-7737
  • Fax: 801-763-7757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5148371
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: