Healthcare Provider Details

I. General information

NPI: 1093062978
Provider Name (Legal Business Name): JFMC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2779 W 4000 S STE 101
ROY UT
84067-9603
US

IV. Provider business mailing address

2779 W 4000 S STE 101
ROY UT
84067-9603
US

V. Phone/Fax

Practice location:
  • Phone: 801-731-5528
  • Fax: 801-731-8369
Mailing address:
  • Phone: 801-731-5528
  • Fax: 801-731-8369

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: DR. MICHAEL GETZ CROOKSTON
Title or Position: CO-OWNER
Credential: DDS
Phone: 801-731-5528