Healthcare Provider Details

I. General information

NPI: 1760513121
Provider Name (Legal Business Name): KARL E LIND DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 SOUTH 1100 EAST SUITE 150
SALT LAKE CITY UT
84124-1266
US

IV. Provider business mailing address

3920 SOUTH 1100 EAST SUITE 150
SALT LAKE CITY UT
84124-1266
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-7447
  • Fax: 801-262-7450
Mailing address:
  • Phone: 801-262-7447
  • Fax: 801-262-7450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1328489924
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number21607
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberS259C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: