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General NPI Number Information
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NPI Number | 1003325374
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Entity Type | Organization
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Legal Business Name | KOS SPANISH FORK LLC
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Dates
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Enumeration Date | 09/29/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 948 N 200 E
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City | SPANISH FORK
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State | UT
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Zip | 84660
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Country | US
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Telephone | 801-361-3926
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Fax |
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Provider Business Mailing Address
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Address Line | 948 N 200 E
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City | SPANISH FORK
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State | UT
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Zip | 84660-1247
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Country | US
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Telephone | 801-798-6000
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. KAMERON KUHNI
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Credential | DMD, MSD
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Telephone | 801-798-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 10294158-9921
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License Number State | UT
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