Healthcare Provider Details

I. General information

NPI: 1982873584
Provider Name (Legal Business Name): JON W SILCOX D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7138 HIGHLAND DR SUITE 213
SALT LAKE CITY UT
84121-3757
US

IV. Provider business mailing address

7138 HIGHLAND DR SUITE 213
SALT LAKE CITY UT
84121-3757
US

V. Phone/Fax

Practice location:
  • Phone: 801-943-4423
  • Fax: 801-943-0458
Mailing address:
  • Phone: 801-943-4423
  • Fax: 801-943-0458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number68070229921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: