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General NPI Number Information
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NPI Number | 1841766821
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Entity Type | Organization
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Legal Business Name | DRY CREEK PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 10/17/2018
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Last Update Date | 10/17/2018
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Provider Practice Location Address
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Address Line | 3300 N RUNNING CREEK WAY F101
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City | LEHI
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State | UT
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Zip | 84043
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Country | US
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Telephone | 801-766-2266
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Fax | 801-653-2000
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Provider Business Mailing Address
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Address Line | 3300 N RUNNING CREEK WAY F101
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City | LEHI
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State | UT
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Zip | 84043
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Country | US
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Telephone | 801-766-2266
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Fax | 801-653-2000
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | HAYLEY BISHOP
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Credential |
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Telephone | 801-766-2266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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