Healthcare Provider Details

I. General information

NPI: 1982207452
Provider Name (Legal Business Name): KAELEE SUE BYINGTON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6944 S WELL SPRING RD APT 8Q
MIDVALE UT
84047-4019
US

IV. Provider business mailing address

6944 S WELL SPRING RD APT 8Q
MIDVALE UT
84047-4019
US

V. Phone/Fax

Practice location:
  • Phone: 801-857-0299
  • Fax:
Mailing address:
  • Phone: 801-857-0299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: