Healthcare Provider Details

I. General information

NPI: 1871055624
Provider Name (Legal Business Name): MARK ASHCRAFT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 N MARKET PLACE DR
CENTERVILLE UT
84014-1702
US

IV. Provider business mailing address

68 W CHASE LN
CENTERVILLE UT
84014-1446
US

V. Phone/Fax

Practice location:
  • Phone: 801-292-9111
  • Fax:
Mailing address:
  • Phone: 801-698-6337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11683197-9923
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: