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General NPI Number Information
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NPI Number | 1619175197
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Entity Type | Organization
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Legal Business Name | JXC LLC
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Dates
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Enumeration Date | 07/06/2007
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 4575 S 5600 W
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City | WEST VALLEY CITY
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State | UT
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Zip | 84120-4639
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Country | US
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Telephone | 801-955-4400
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Fax | 801-955-4900
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Provider Business Mailing Address
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Address Line | 4575 S 5600 W
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City | WEST VALLEY CITY
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State | UT
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Zip | 84120-4639
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Country | US
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Telephone | 801-955-4400
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Fax | 801-955-4900
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | BRION CONWAY
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Credential |
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Telephone | 801-955-4400
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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 | 6994989
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 7992771
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License Number State | UT
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