MEDICARE: AARON PRESTON ROUNDY 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	7718138-9922	UT

General Provider Information

NPI Number	:	1235404096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON PRESTON ROUNDY DDS

Provider Business Mailing Address
First Line	:	7138 HIGHLAND DR STE 215
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3784
Country	:	US
Telephone Number	:	801-943-9194
Fax Number	:	801-943-1810

Provider Business Practice Location Address
First Line	:	7138 HIGHLAND DR STE 215
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3784
Country	:	US
Telephone Number	:	801-943-9194
Fax Number	:	801-943-1810

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

Provider Enumeration Date	:	03/13/2012
Last Update Date	:	03/13/2012

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