=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902598683
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL RYAN SCHOUTEN DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2023
-----------------------------------------------------
Last Update Date | 05/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 133 S 500 E
-----------------------------------------------------
City | VERNAL
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84078-9903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-247-1190
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12090 S 3600 W
-----------------------------------------------------
City | RIVERTON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84065-7607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-824-7344
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223D0001X
-----------------------------------------------------
Taxonomy Name | Public Health Dentistry
-----------------------------------------------------
License Number | 13405471-9922
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------