Healthcare Provider Details

I. General information

NPI: 1720564883
Provider Name (Legal Business Name): KEITH EGAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N CATHERINE ST
SALT LAKE CITY UT
84116-1600
US

IV. Provider business mailing address

1011 N CATHERINE ST
SALT LAKE CITY UT
84116-1600
US

V. Phone/Fax

Practice location:
  • Phone: 801-596-3000
  • Fax:
Mailing address:
  • Phone: 801-596-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9865733
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: