Healthcare Provider Details

I. General information

NPI: 1972248557
Provider Name (Legal Business Name): CARE ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E 5600 S FL 1
SALT LAKE CITY UT
84107-6181
US

IV. Provider business mailing address

4942 S COTTONWOOD LN
HOLLADAY UT
84117-6256
US

V. Phone/Fax

Practice location:
  • Phone: 801-631-1312
  • Fax:
Mailing address:
  • Phone: 801-631-1312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State

VIII. Authorized Official

Name: DR. MITCHELL DOUGLAS DUCKWORTH
Title or Position: OWNER
Credential: DDS
Phone: 801-631-1312