Healthcare Provider Details

I. General information

NPI: 1154257251
Provider Name (Legal Business Name): KATHRYN VELA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1459 N MAIN ST STE 3
BOUNTIFUL UT
84010-6497
US

IV. Provider business mailing address

455 W 200 N UNIT 204
SALT LAKE CITY UT
84103-1165
US

V. Phone/Fax

Practice location:
  • Phone: 801-292-4440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14292767-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: