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General NPI Number Information
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NPI Number | 1972100295
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Entity Type | Individual
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Provider Name | RILEY HUNSAKER
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Gender | Male
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Dates
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Enumeration Date | 10/09/2020
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | 10654 S RIVER HEIGHTS DR
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-5522
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Country | US
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Telephone | 801-472-7919
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Fax |
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Provider Business Mailing Address
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Address Line | 5017 W LONDON BAY DR
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City | RIVERTON
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State | UT
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Zip | 84096-1900
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Country | US
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Telephone | 801-472-7919
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 11677059-9921
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License Number State | UT
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