Healthcare Provider Details

I. General information

NPI: 1023493046
Provider Name (Legal Business Name): ALLEN JON DAVIS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E 100 N STE 155
PAYSON UT
84651-1638
US

IV. Provider business mailing address

304 E SOUTHFIELD RD
SPANISH FORK UT
84660-9789
US

V. Phone/Fax

Practice location:
  • Phone: 385-483-7378
  • Fax:
Mailing address:
  • Phone: 801-885-4095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number94297668-9921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: