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General NPI Number Information
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NPI Number | 1790301877
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Entity Type | Individual
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Provider Name | TAYLOR DUDLEY DMD
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Gender | Male
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Dates
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Enumeration Date | 06/24/2020
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Last Update Date | 06/24/2020
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Provider Practice Location Address
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Address Line | 5396 W DAYBREAK PKWY
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City | SOUTH JORDAN
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State | UT
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Zip | 84009-5900
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Country | US
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Telephone | 801-614-7669
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Fax |
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Provider Business Mailing Address
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Address Line | 710 E 230 N
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City | LINDON
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State | UT
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Zip | 84042-2518
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11816849-9922
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License Number State | UT
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