MEDICARE: KENT A GIAUQUE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2078	UT

General Provider Information

NPI Number	:	1063672590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENT A GIAUQUE DDS

Provider Business Mailing Address
First Line	:	1345 E 3900 S
Second Line	:	# 210
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1474
Country	:	US
Telephone Number	:	801-272-4466
Fax Number	:

Provider Business Practice Location Address
First Line	:	1345 E 3900 S
Second Line	:	# 210
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1474
Country	:	US
Telephone Number	:	801-272-4466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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