Healthcare Provider Details

I. General information

NPI: 1487580569
Provider Name (Legal Business Name): BIANCA BERNARDO AFONSO AGUIRRES DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6973 S COUGAR LN STE D
WEST JORDAN UT
84084-7927
US

IV. Provider business mailing address

2354 E SPRING ST
EAGLE MOUNTAIN UT
84005-6543
US

V. Phone/Fax

Practice location:
  • Phone: 801-982-0332
  • Fax:
Mailing address:
  • Phone: 385-270-7374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14290510-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: