Healthcare Provider Details

I. General information

NPI: 1972549418
Provider Name (Legal Business Name): SCOTT PAUL COLD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4546 S ATHERTON DR STE 201
SALT LAKE CITY UT
84123-6968
US

IV. Provider business mailing address

4546 S ATHERTON DR STE 201
SALT LAKE CITY UT
84123-6968
US

V. Phone/Fax

Practice location:
  • Phone: 801-965-9898
  • Fax: 801-965-6194
Mailing address:
  • Phone: 801-965-9898
  • Fax: 801-965-6194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5329217-9922
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number5329217-9922
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5329217-9922
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5329217-9922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: