Healthcare Provider Details

I. General information

NPI: 1376893370
Provider Name (Legal Business Name): KENNETH G. BILLS D.D.S. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 E 4500 S SUITE 240
SALT LAKE CITY UT
84117-4434
US

IV. Provider business mailing address

2180 E 4500 S SUITE 240
SALT LAKE CITY UT
84117-4434
US

V. Phone/Fax

Practice location:
  • Phone: 801-277-0090
  • Fax: 801-277-0092
Mailing address:
  • Phone: 801-277-0090
  • Fax: 801-277-0092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number221387029922
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number221387029922
License Number StateUT

VIII. Authorized Official

Name: DR. KENNETH GENE BILLS
Title or Position: CEO
Credential: D.D.S.
Phone: 801-277-0090