MEDICARE: CEDAR VIEW PEDIATRIC DENITSTRY

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	1223P0221X	Pediatric Dentistry	63359359921	UT

General Provider Information

NPI Number	:	1093838377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEDAR VIEW PEDIATRIC DENITSTRY

Provider Business Mailing Address
First Line	:	1251 NORTHFIELD RD
Second Line	:	201
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-8916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1251 NORTHFIELD RD
Second Line	:	201
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-8916
Country	:	US
Telephone Number	:	435-586-8188
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TYLER ROBERT ALBRECHT
Credential	:	DMD
Telephone Number	:	435-586-8188

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	08/22/2020

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