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NPI Code Detail

MEDICARE: BRIGHAM STOKER DDS

MEDICARE: BRIGHAM STOKER 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
11223G0001XGeneral Practice Dentistry7682349UT

General Provider Information

NPI Number : 1114248762
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIGHAM STOKER DDS
Provider Business Mailing Address
First Line : 144 S 700 E
Second Line : SUITE 2
City : SALT LAKE CITY
State : UT
Zip : 84102-1109
Country : US
Telephone Number : 801-505-6850
Fax Number :
Provider Business Practice Location Address
First Line : 144 S 700 E
Second Line : SUITE 2
City : SALT LAKE CITY
State : UT
Zip : 84102-1109
Country : US
Telephone Number : 801-505-6850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2010
Last Update Date : 07/25/2011

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Directions to “ BRIGHAM STOKER DDS” Practice Location

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