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General NPI Number Information
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NPI Number | 1811685993
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Entity Type | Individual
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Provider Name | BRADEN CLINT HARRIS DMD
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Gender | Male
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 415 MEDICAL DR STE D201
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City | BOUNTIFUL
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State | UT
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Zip | 84010-4983
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Country | US
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Telephone | 8
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Fax |
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Provider Business Mailing Address
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Address Line | 6682 S 2850 E
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City | OGDEN
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State | UT
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Zip | 84403-5445
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Country | US
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Telephone | 801-668-4542
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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 | 13372970-9922
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License Number State | UT
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