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General NPI Number Information
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NPI Number | 1467373449
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Entity Type | Organization
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Legal Business Name | UTAH DENTAL ANESTHESIA PLLC
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Dates
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Enumeration Date | 07/23/2026
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Last Update Date | 07/23/2026
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Provider Practice Location Address
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Address Line | 1028 W 950 N STE 102
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City | OREM
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State | UT
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Zip | 84057-4171
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Country | US
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Telephone | 208-559-5518
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Fax |
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Provider Business Mailing Address
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Address Line | 1310 S VISTA AVE SUITE 21
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City | BOISE
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State | ID
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Zip | 83705
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Country | US
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Telephone | 208-559-5518
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAKE WOOD
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Credential | DMD, MPH
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Telephone | 208-559-5518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number |
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License Number State |
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