Healthcare Provider Details

I. General information

NPI: 1023645454
Provider Name (Legal Business Name): BRITTNEY PAULINE CISZEK DDS, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 S WAKARA WAY
SALT LAKE CITY UT
84108-1213
US

IV. Provider business mailing address

530 S WAKARA WAY
SALT LAKE CITY UT
84108-1213
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-2162
  • Fax:
Mailing address:
  • Phone: 801-587-2162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12224671-9924
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: