=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033372297
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRAPNELL ORTHODONTICS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2008
-----------------------------------------------------
Last Update Date | 07/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 89 W 900 N
-----------------------------------------------------
City | SPANISH FORK
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84660-1161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-798-8343
-----------------------------------------------------
Fax | 801-798-7506
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1107 S HIGHWAY 198 P.O. BOX 406
-----------------------------------------------------
City | PAYSON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84651-3213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-465-2541
-----------------------------------------------------
Fax | 801-465-1169
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CHRISTOPHER J. TRAPNELL
-----------------------------------------------------
Credential | DDSMS
-----------------------------------------------------
Telephone | 801-465-2541
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 367768-9922
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------