Healthcare Provider Details

I. General information

NPI: 1003028325
Provider Name (Legal Business Name): PEDIATRIC DENTISTRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 N HILL FIELD RD STE 1
LAYTON UT
84041-4023
US

IV. Provider business mailing address

2112 N HILL FIELD RD STE 1
LAYTON UT
84041-4023
US

V. Phone/Fax

Practice location:
  • Phone: 801-774-0770
  • Fax:
Mailing address:
  • Phone: 801-774-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number145535
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number145535
License Number StateUT

VIII. Authorized Official

Name: S. DALE HIBBERT
Title or Position: OWNER
Credential:
Phone: 801-774-0770