Healthcare Provider Details

I. General information

NPI: 1457850844
Provider Name (Legal Business Name): SUNSET SMILES DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 W SUNSET BLVD STE 15
ST GEORGE UT
84770-4849
US

IV. Provider business mailing address

929 W SUNSET BLVD STE 15
ST GEORGE UT
84770-4849
US

V. Phone/Fax

Practice location:
  • Phone: 435-656-5900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateUT

VIII. Authorized Official

Name: KEVIN DORIUS
Title or Position: PART OWNER
Credential: DMD
Phone: 435-656-5900