Healthcare Provider Details

I. General information

NPI: 1497029052
Provider Name (Legal Business Name): FRANDSEN FAMILY DENTISTRY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 S OREM BLVD
OREM UT
84058-3006
US

IV. Provider business mailing address

165 S OREM BLVD
OREM UT
84058-3006
US

V. Phone/Fax

Practice location:
  • Phone: 801-224-7900
  • Fax:
Mailing address:
  • Phone: 801-224-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number51251339921
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. BRIAN LLOYD FRANDSEN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 801-699-9047