Healthcare Provider Details

I. General information

NPI: 1689781189
Provider Name (Legal Business Name): CREED S HAYMOND DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 E 9400 S STE 102
SANDY UT
84093
US

IV. Provider business mailing address

1434 E 9400 S STE 102
SANDY UT
84093
US

V. Phone/Fax

Practice location:
  • Phone: 801-576-0077
  • Fax: 801-495-1837
Mailing address:
  • Phone: 801-576-0077
  • Fax: 801-495-1837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1453789924
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1453788903
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: