Healthcare Provider Details

I. General information

NPI: 1699396168
Provider Name (Legal Business Name): MOUNTAIN VIEW PEDIATRIC DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

2719 N HIGHWAY 89 STE 200
PLEASANT VIEW UT
84404-6257
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 Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAMERON QUAYLE
Title or Position: DOCTOR/DENTIST
Credential: DDS
Phone: 801-737-5437