Healthcare Provider Details

I. General information

NPI: 1225968720
Provider Name (Legal Business Name): KIROLLOS SEMARY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 E UNIVERSITY PKWY
OREM UT
84058-7601
US

IV. Provider business mailing address

11604 S OLD CEDAR DR
SOUTH JORDAN UT
84095-1308
US

V. Phone/Fax

Practice location:
  • Phone: 801-851-1021
  • Fax:
Mailing address:
  • Phone: 925-565-1158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14286872-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: