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General NPI Number Information
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NPI Number | 1154744399
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Entity Type | Organization
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Legal Business Name | ISMILE AT SLC
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Dates
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Enumeration Date | 01/23/2014
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Last Update Date | 01/23/2014
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Provider Practice Location Address
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Address Line | 302 N MAIN ST
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City | KAYSVILLE
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State | UT
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Zip | 84037-6766
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Country | US
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Telephone | 801-544-3953
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Fax | 801-660-1312
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Provider Business Mailing Address
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Address Line | 928 E 100 S SUITE E
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-1455
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Country | US
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Telephone | 801-355-5657
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Fax | 801-660-1312
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | DR. JASON G BARTON
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Credential | DDS
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Telephone | 801-544-3953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5310263
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License Number State | UT
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