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General NPI Number Information
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NPI Number | 1003028325
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY, P.C.
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2112 N HILL FIELD RD STE 1
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City | LAYTON
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State | UT
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Zip | 84041-4023
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Country | US
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Telephone | 801-774-0770
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Fax |
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Provider Business Mailing Address
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Address Line | 2112 N HILL FIELD RD STE 1
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City | LAYTON
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State | UT
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Zip | 84041-4023
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Country | US
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Telephone | 801-774-0770
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | S. DALE HIBBERT
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Credential |
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Telephone | 801-774-0770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 145535
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 145535
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License Number State | UT
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