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General NPI Number Information
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NPI Number | 1629298427
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Entity Type | Organization
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Legal Business Name | J D UTLEY JR DMD PC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3900 ZUCK ROAD
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City | ERIE
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State | PA
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Zip | 16506
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Country | US
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Telephone | 814-833-5322
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Fax | 814-838-8718
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Provider Business Mailing Address
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Address Line | 3900 ZUCK ROAD
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City | ERIE
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State | PA
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Zip | 16506
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Country | US
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Telephone | 814-833-5322
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Fax | 814-838-8718
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK D UTLEY JR.
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Credential | DMD
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Telephone | 814-833-5322
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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 | DS018914L
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License Number State | PA
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