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General NPI Number Information
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NPI Number | 1538200316
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Entity Type | Organization
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Legal Business Name | YOUNG FAMILY DENTAL SS
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 1416 N REDWOOD RD
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City | SARATOGA SPRINGS
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State | UT
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Zip | 84045-6455
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Country | US
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Telephone | 801-766-2112
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Fax | 801-766-5993
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Provider Business Mailing Address
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Address Line | 1416 N REDWOOD RD
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City | SARATOGA SPRINGS
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State | UT
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Zip | 84045
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Country | US
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Telephone | 801-766-2112
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Fax | 801-766-5993
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SUSAN J JOHN
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Credential |
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Telephone | 801-766-2112
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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 | 4766943-9922
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License Number State | UT
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