Healthcare Provider Details

I. General information

NPI: 1407939986
Provider Name (Legal Business Name): EVRON KNORR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#5 SOUTH 700 E SUITE 205
SALT LAKE CITY UT
84102
US

IV. Provider business mailing address

#5 SOUTH 700 E SUITE 205
SALT LAKE CITY UT
84102
US

V. Phone/Fax

Practice location:
  • Phone: 801-355-8029
  • Fax:
Mailing address:
  • Phone: 801-355-8029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1313399921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: