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General NPI Number Information
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NPI Number | 1184096026
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Entity Type | Organization
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Legal Business Name | ASHLEY VALLEY FAMILY DENTAL
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Dates
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Enumeration Date | 10/29/2015
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 606 N 1700 W
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City | VERNAL
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State | UT
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Zip | 84078-8200
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Country | US
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Telephone | 435-789-1748
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Fax | 435-781-0081
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Provider Business Mailing Address
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Address Line | 606 N 1700 W
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City | VERNAL
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State | UT
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Zip | 84078-8200
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Country | US
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Telephone | 435-789-1748
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Fax | 435-781-0081
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Authorized Official
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Title or Position | DENTIST
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Name | JEREMY BRIAN ABRAMS
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Credential | D.M.D.
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Telephone | 435-789-1748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6221913-9922
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4920693-9922
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License Number State | UT
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