Healthcare Provider Details

I. General information

NPI: 1376745661
Provider Name (Legal Business Name): DANIEL S BETHERS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 S RIVER RD BUILDING E SUITE 2
SAINT GEORGE UT
84790-8285
US

IV. Provider business mailing address

1765 W 70 SOUTH CIR
SAINT GEORGE UT
84770-5034
US

V. Phone/Fax

Practice location:
  • Phone: 435-674-7430
  • Fax: 435-669-6275
Mailing address:
  • Phone: 435-674-1538
  • Fax: 435-669-6275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5895914-9921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: