Healthcare Provider Details

I. General information

NPI: 1851311187
Provider Name (Legal Business Name): ROBERT WILLIAM PRINCE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 S MAIN ST STE 2
SAINT GEORGE UT
84770-5506
US

IV. Provider business mailing address

754 S MAIN ST STE 2
SAINT GEORGE UT
84770-5506
US

V. Phone/Fax

Practice location:
  • Phone: 435-673-1171
  • Fax: 435-673-7799
Mailing address:
  • Phone: 435-673-1171
  • Fax: 435-673-7799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number141333-9922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: