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General NPI Number Information
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NPI Number | 1427997295
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Entity Type | Organization
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Legal Business Name | KDE DENTAL PLLC
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Dates
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Enumeration Date | 03/26/2026
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Last Update Date | 03/26/2026
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Provider Practice Location Address
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Address Line | 1011 N CATHERINE ST
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City | SALT LAKE CITY
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State | UT
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Zip | 84116-1600
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Country | US
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Telephone | 801-596-3000
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Fax | 801-596-8887
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Provider Business Mailing Address
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Address Line | 1011 N CATHERINE ST
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City | SALT LAKE CITY
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State | UT
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Zip | 84116-1600
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Country | US
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Telephone | 801-596-3000
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Fax | 801-596-8887
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Authorized Official
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Title or Position | MANAGING MEMBER / GENERAL DENTIST
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Name | DR. KEITH D EGAN
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Credential | DDS
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Telephone | 801-547-7204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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