Healthcare Provider Details

I. General information

NPI: 1598256026
Provider Name (Legal Business Name): EMILY RAE BRONS-PICHE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8706 S 700 E STE 100
SANDY UT
84070-1808
US

IV. Provider business mailing address

8706 S 700 E STE 100
SANDY UT
84070-1808
US

V. Phone/Fax

Practice location:
  • Phone: 801-255-3351
  • Fax:
Mailing address:
  • Phone: 15-724-4048
  • Fax: 801-572-4405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12720110-9923
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901022569
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: