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General NPI Number Information
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NPI Number | 1366014730
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Entity Type | Individual
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Provider Name | JASEN SCOTT DEBRINE
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Gender | Male
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Dates
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Enumeration Date | 07/14/2021
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 82 E 900 N STE A
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City | SPANISH FORK
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State | UT
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Zip | 84660-1244
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Country | US
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Telephone | 801-798-3526
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Fax | 801-798-1186
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Provider Business Mailing Address
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Address Line | 82 E 900 N STE A
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City | SPANISH FORK
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State | UT
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Zip | 84660-1244
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Country | US
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Telephone | 801-798-3526
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Fax | 801-798-1186
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6110076
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License Number State | UT
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