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General NPI Number Information
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NPI Number | 1346884335
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Entity Type | Organization
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Legal Business Name | ORTHODONTICS OF ST. GEORGE, P.C.
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Dates
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Enumeration Date | 11/01/2019
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Last Update Date | 11/01/2019
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Provider Practice Location Address
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Address Line | 965 E 700 S STE 101
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City | ST GEORGE
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State | UT
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Zip | 84790-4084
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Country | US
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Telephone | 435-688-7711
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Fax |
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Provider Business Mailing Address
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Address Line | 4760 N BUTLER AVE STE B
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City | FARMINGTON
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State | NM
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Zip | 87401-0816
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Country | US
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Telephone | 505-592-0482
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Fax | 505-325-2538
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Authorized Official
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Title or Position | BILLING
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Name | MISTY M ABEYTA
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Credential |
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Telephone | 505-592-0482
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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 |
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License Number State |
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