Healthcare Provider Details

I. General information

NPI: 1083705149
Provider Name (Legal Business Name): SAMUEL D KNIGHT DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1741 N 2000 W
FARR WEST UT
84404
US

IV. Provider business mailing address

1761 NORTH 2000 WEST
FARR WEST UT
84404
US

V. Phone/Fax

Practice location:
  • Phone: 801-731-3200
  • Fax: 801-477-8925
Mailing address:
  • Phone: 801-731-3200
  • Fax: 801-731-1051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number1439458903
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1439459923
License Number StateUT

VIII. Authorized Official

Name: DR. SAMUEL DON KNIGHT
Title or Position: DENTIST
Credential: DDS
Phone: 801-731-3200