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General NPI Number Information
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NPI Number | 1790796258
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Entity Type | Individual
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Provider Name | EDWARD JAMES SITTLER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 14717 MINUTEMAN DR. UTAH DEPARTMENT OF CORRECTIONS-CLINICAL SERVICES
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City | DRAPER
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State | UT
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Zip | 84020
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Country | US
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Telephone | 801-576-7107
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Fax |
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Provider Business Mailing Address
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Address Line | 2711 DEER MEADOW DR
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City | LEHI
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State | UT
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Zip | 84043-5554
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Country | US
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Telephone | 801-602-6941
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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 | 59894059921
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License Number State | UT
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