Healthcare Provider Details

I. General information

NPI: 1205642220
Provider Name (Legal Business Name): LANCE D CROWTHER DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 E 100 N
MORGAN UT
84050-9203
US

IV. Provider business mailing address

PO BOX 721
MORGAN UT
84050-0721
US

V. Phone/Fax

Practice location:
  • Phone: 801-829-6471
  • Fax: 801-829-6475
Mailing address:
  • Phone: 801-829-6471
  • Fax: 801-829-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: LANCE CROWTHER
Title or Position: OFFICE MANAGER
Credential:
Phone: 801-829-6471