Healthcare Provider Details

I. General information

NPI: 1922663210
Provider Name (Legal Business Name): SHELLEY D BROWN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 E 300 N
OREM UT
84057-4712
US

IV. Provider business mailing address

180 E 300 N
OREM UT
84057-4712
US

V. Phone/Fax

Practice location:
  • Phone: 801-367-0219
  • Fax:
Mailing address:
  • Phone: 801-367-0219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number7048714-9920
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: