Healthcare Provider Details

I. General information

NPI: 1437598521
Provider Name (Legal Business Name): DESERT ENDODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 S RIVER RD STE 2
SAINT GEORGE UT
84790-8285
US

IV. Provider business mailing address

1224 S RIVER RD STE 2
SAINT GEORGE UT
84790-8285
US

V. Phone/Fax

Practice location:
  • Phone: 435-674-7430
  • Fax: 435-674-4431
Mailing address:
  • Phone: 435-674-7430
  • Fax: 435-674-4431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL BETHERS
Title or Position: MANAGING PARTNER
Credential: DO
Phone: 435-674-7430