Healthcare Provider Details

I. General information

NPI: 1740119726
Provider Name (Legal Business Name): LYN MOUHAFFEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10894 S RIVER FRONT PKWY
SOUTH JORDAN UT
84095-5609
US

IV. Provider business mailing address

3657 W SURI RISE LN UNIT J201
HERRIMAN UT
84096-2450
US

V. Phone/Fax

Practice location:
  • Phone: 801-878-1251
  • Fax:
Mailing address:
  • Phone: 318-737-6779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: