Healthcare Provider Details

I. General information

NPI: 1700617685
Provider Name (Legal Business Name): JENNA LEE MCCARTHY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5872 S 900 E STE 252
MURRAY UT
84121-1678
US

IV. Provider business mailing address

9 RIVER REACH CT APT C
ALTON IL
62002-7396
US

V. Phone/Fax

Practice location:
  • Phone: 801-278-3214
  • Fax:
Mailing address:
  • Phone: 916-474-0580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019035220
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14278712-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: