Healthcare Provider Details

I. General information

NPI: 1821155581
Provider Name (Legal Business Name): MOYES IVERSON DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 E 5625 SO STE 2
OGDEN UT
84403
US

IV. Provider business mailing address

1770 E 5625 SO STE 2
OGDEN UT
84403
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-1999
  • Fax: 801-475-1888
Mailing address:
  • Phone: 801-475-1999
  • Fax: 801-475-1888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRETT KIRK MOYES
Title or Position: DOCTOR
Credential: DDS
Phone: 801-475-1999