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General NPI Number Information
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NPI Number | 1073758843
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Entity Type | Organization
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Legal Business Name | IVERSON & LARSEN DENTAL PLLC
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Dates
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Enumeration Date | 12/09/2008
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Last Update Date | 12/09/2008
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Provider Practice Location Address
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Address Line | 2627 N HIGHWAY 162
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City | EDEN
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State | UT
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Zip | 84310-9745
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Country | US
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Telephone | 801-745-3882
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Fax | 801-745-6207
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Provider Business Mailing Address
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Address Line | 2627 N HIGHWAY 162
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City | EDEN
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State | UT
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Zip | 84310-9745
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Country | US
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Telephone | 801-745-3882
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Fax | 801-745-6207
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Authorized Official
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Title or Position | MANAGER
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Name | DR. VERN Q IVERSON
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Credential | D.D.S.
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Telephone | 801-745-3882
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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 |
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License Number State | UT
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