Healthcare Provider Details

I. General information

NPI: 1750736377
Provider Name (Legal Business Name): MOUNTAIN VIEW PEDIATRIC DENTISTRY OF FARMINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 SHEPARD LANE, STE 100
FARMINGTON UT
84025-2702
US

IV. Provider business mailing address

991 SHEPARD LANE, STE 100
FARMINGTON UT
84025-2702
US

V. Phone/Fax

Practice location:
  • Phone: 801-447-5437
  • Fax: 801-447-4685
Mailing address:
  • Phone: 801-447-5437
  • Fax: 801-447-4685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CAMERON PAUL QUAYLE
Title or Position: OWNER/DOCTOR
Credential: DDS
Phone: 801-447-5437