Healthcare Provider Details

I. General information

NPI: 1790905578
Provider Name (Legal Business Name): JEFFREY S KNIGHT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 S 1300 E SUITE 3
SALT LAKE CITY UT
84105-3638
US

IV. Provider business mailing address

1955 S 1300 E SUITE 3
SALT LAKE CITY UT
84105-3638
US

V. Phone/Fax

Practice location:
  • Phone: 801-487-5807
  • Fax: 801-487-3438
Mailing address:
  • Phone: 801-487-5807
  • Fax: 801-487-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number264810-9923
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: