Healthcare Provider Details

I. General information

NPI: 1962355222
Provider Name (Legal Business Name): CARE SPECIAL NEEDS DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E 5600 S STE 104
SALT LAKE CITY UT
84107-8140
US

IV. Provider business mailing address

151 E 5600 S STE 100
SALT LAKE CITY UT
84107-8139
US

V. Phone/Fax

Practice location:
  • Phone: 801-833-0515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: GARY BRANDON KEHL
Title or Position: MANAGING MEMBER
Credential:
Phone: 801-560-6408