=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154573129
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CEDAR VIEW PEDIATRIC DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2008
-----------------------------------------------------
Last Update Date | 10/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1251 N. NORTHFIELD RD. STE 201
-----------------------------------------------------
City | CEDAR CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-586-8188
-----------------------------------------------------
Fax | 435-867-1362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1251 N. NORTHFIELD RD. STE 201
-----------------------------------------------------
City | CEDAR CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-586-8188
-----------------------------------------------------
Fax | 435-867-1362
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PEDIATRIC DENTIST
-----------------------------------------------------
Name | DR. TYLER ROBERT ALBRECHT
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 435-586-8188
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------