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General NPI Number Information
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NPI Number | 1992913552
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Entity Type | Organization
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Legal Business Name | TULLIS & TWITCHELL DMD LLC
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5547 S 4015 W SUITE 1
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City | TAYLORSVILLE
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State | UT
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Zip | 84118-4437
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Country | US
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Telephone | 801-968-3585
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Fax | 801-968-3586
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Provider Business Mailing Address
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Address Line | 5547 S 4015 W SUITE 1
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City | TAYLORSVILLE
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State | UT
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Zip | 84118-4437
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Country | US
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Telephone | 801-968-3585
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Fax | 801-968-3586
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRENT RULON TWITCHELL
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Credential | DMD
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Telephone | 801-968-3585
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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 | 5665059-9922
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License Number State | UT
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