Healthcare Provider Details

I. General information

NPI: 1447652896
Provider Name (Legal Business Name): CARDON ENDODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E 500 N
SPANISH FORK UT
84660-1515
US

IV. Provider business mailing address

41 E 500 N
SPANISH FORK UT
84660-1515
US

V. Phone/Fax

Practice location:
  • Phone: 801-504-6295
  • Fax: 801-504-6548
Mailing address:
  • Phone: 801-504-6295
  • Fax: 801-504-6548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number9074817
License Number StateUT

VIII. Authorized Official

Name: BRYAN CARDON
Title or Position: PRESIDENT
Credential: DMD
Phone: 801-504-6295