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General NPI Number Information
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NPI Number | 1245519750
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Entity Type | Organization
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Legal Business Name | GRANGER ORTHODONTICS
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Dates
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Enumeration Date | 08/15/2011
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Last Update Date | 08/15/2011
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Provider Practice Location Address
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Address Line | 3725 W 4100 S
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City | SALT LAKE CITY
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State | UT
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Zip | 84120-5530
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Country | US
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Telephone | 801-966-6681
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Fax | 801-966-6600
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Provider Business Mailing Address
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Address Line | 3725 W 4100 S
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City | SALT LAKE CITY
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State | UT
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Zip | 84120-5530
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Country | US
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Telephone | 801-966-6681
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Fax | 801-966-6600
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT R TAYLOR
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Credential | DMF
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Telephone | 801-966-6681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 7026989
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License Number State | UT
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