Healthcare Provider Details

I. General information

NPI: 1366647414
Provider Name (Legal Business Name): JOHN R SCHOUTEN D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 E 400 S STE 2
SPRINGVILLE UT
84663-1982
US

IV. Provider business mailing address

1513 E 300 S
SPRINGVILLE UT
84663-2771
US

V. Phone/Fax

Practice location:
  • Phone: 801-491-9372
  • Fax: 801-491-0856
Mailing address:
  • Phone: 801-491-8470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number375746-9921
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1055
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: