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General NPI Number Information
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NPI Number | 1225184625
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Entity Type | Organization
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Legal Business Name | TIMPANOGAS PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 25 NORTH 1100 EAST
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City | AMERICAN FORK
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State | UT
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Zip | 84003
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Country | US
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Telephone | 801-492-1346
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Fax | 801-492-1320
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Provider Business Mailing Address
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Address Line | 25 NORTH 1100 EAST
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City | AMERICAN FORK
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State | UT
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Zip | 84003
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Country | US
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Telephone | 801-492-1346
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Fax | 801-492-1320
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Authorized Official
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Title or Position | SURGEON
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Name | MR. SCOTT A JENSEN
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Credential |
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Telephone | 801-492-1346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 3085413-9923
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License Number State | UT
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