Healthcare Provider Details

I. General information

NPI: 1427997295
Provider Name (Legal Business Name): KDE DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
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: 801-596-8887
Mailing address:
  • Phone: 801-596-3000
  • Fax: 801-596-8887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH D EGAN
Title or Position: MANAGING MEMBER / GENERAL DENTIST
Credential: DDS
Phone: 801-547-7204