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General NPI Number Information
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NPI Number | 1306152889
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Entity Type | Individual
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Provider Name | MCKINSEE BRODERICK WEYHER DDS
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Gender | Female
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Dates
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Enumeration Date | 08/23/2010
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Last Update Date | 12/31/2016
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Provider Practice Location Address
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Address Line | 2114 S HIGHLAND DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84106-2807
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Country | US
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Telephone | 385-399-0537
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Fax | 801-880-8835
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Provider Business Mailing Address
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Address Line | 2114 S HIGHLAND DR
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City | SALT LAKE CITY
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State | UT
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Zip | 84106-2807
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Country | US
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Telephone | 385-399-0537
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Fax | 801-880-8835
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 59546
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1361
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8088273-9922
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License Number State | UT
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