Healthcare Provider Details

I. General information

NPI: 1356094247
Provider Name (Legal Business Name): SIERRA BODILY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E 5600 S
MURRAY UT
84107-6181
US

IV. Provider business mailing address

16 S 200 E
KAYSVILLE UT
84037-2018
US

V. Phone/Fax

Practice location:
  • Phone: 208-852-1560
  • Fax: 208-852-1560
Mailing address:
  • Phone: 208-852-1560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number12782441-9924
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number5171473
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: