Healthcare Provider Details

I. General information

NPI: 1891623732
Provider Name (Legal Business Name): ATKINSON DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5903 W EMMELINE DR
HERRIMAN UT
84096-1879
US

IV. Provider business mailing address

5903 W EMMELINE DR
HERRIMAN UT
84096-1879
US

V. Phone/Fax

Practice location:
  • Phone: 801-599-0960
  • Fax:
Mailing address:
  • Phone: 801-599-0960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL LIONEL ATKINSON
Title or Position: CO-FOUNDER
Credential: PHD
Phone: 801-599-0960