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General NPI Number Information
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NPI Number | 1023186111
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Entity Type | Organization
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Legal Business Name | RAYMOND SCOTT HLAVATY
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 150 E 200 NO STE A
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City | LOGAN
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State | UT
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Zip | 84321
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Country | US
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Telephone | 435-753-2828
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Fax | 435-753-3628
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Provider Business Mailing Address
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Address Line | 150 E 200 NO STE A
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City | LOGAN
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State | UT
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Zip | 84321
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Country | US
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Telephone | 435-753-2828
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Fax | 435-753-3628
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. RAYMOND SCOTT HLAVATY
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Credential | DMD MS
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Telephone | 435-753-2828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 932604579921
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License Number State | UT
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