Healthcare Provider Details

I. General information

NPI: 1962555862
Provider Name (Legal Business Name): BRANDI LEIGH OBERG D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 N MAIN ST SUITE #101
CLEARFIELD UT
84015-3222
US

IV. Provider business mailing address

289 E 900 S
LAYTON UT
84041-4149
US

V. Phone/Fax

Practice location:
  • Phone: 801-776-8441
  • Fax: 801-776-8428
Mailing address:
  • Phone: 801-546-4529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number373633-9922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: