Healthcare Provider Details

I. General information

NPI: 1619797008
Provider Name (Legal Business Name): SBB GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 W 1700 S
SYRACUSE UT
84075
US

IV. Provider business mailing address

201 N WELDEN WAY
LAYTON UT
84041-8864
US

V. Phone/Fax

Practice location:
  • Phone: 801-888-4912
  • Fax:
Mailing address:
  • Phone: 801-888-4912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TAYLOR JAY ALLRED
Title or Position: OWNER
Credential: DMD
Phone: 801-888-4912