Healthcare Provider Details

I. General information

NPI: 1619860665
Provider Name (Legal Business Name): BROOKLYN JANES DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 N WINDING RIVER AVE
LEHI UT
84043-4628
US

IV. Provider business mailing address

532 N WINDING RIVER AVE
LEHI UT
84043-4628
US

V. Phone/Fax

Practice location:
  • Phone: 435-879-1913
  • Fax:
Mailing address:
  • Phone: 435-879-1913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10001363
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: