Healthcare Provider Details

I. General information

NPI: 1881097269
Provider Name (Legal Business Name): SAVANNAH MOTT D.V.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5714 W 13400 S
HERRIMAN UT
84096-6907
US

IV. Provider business mailing address

1593 W SECRET GARDEN PL APT 257
SALT LAKE CITY UT
84104-4051
US

V. Phone/Fax

Practice location:
  • Phone: 801-446-5194
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number90612112802
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: