Healthcare Provider Details

I. General information

NPI: 1225194046
Provider Name (Legal Business Name): CAMERON P QUAYLE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2719 N HIGHWAY 89 STE 200 SUITE 200
PLEASANT VIEW UT
84404-6257
US

IV. Provider business mailing address

2719 N HIGHWAY 89 SUITE 200
PLEASANT VIEW UT
84404-6256
US

V. Phone/Fax

Practice location:
  • Phone: 801-737-5437
  • Fax: 801-737-5452
Mailing address:
  • Phone: 801-737-5437
  • Fax: 801-737-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5776592
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: