Healthcare Provider Details

I. General information

NPI: 1497114870
Provider Name (Legal Business Name): TRENTON JOHNSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10157 S 940 W
SOUTH JORDAN UT
84095
US

IV. Provider business mailing address

10157 S 940 W
SOUTH JORDAN UT
84095-4635
US

V. Phone/Fax

Practice location:
  • Phone: 801-879-0400
  • Fax:
Mailing address:
  • Phone: 801-879-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number10762199-9921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: