MEDICARE: GRANGER ORTHODONTICS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	7026989	UT

General Provider Information

NPI Number	:	1245519750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANGER ORTHODONTICS

Provider Business Mailing Address
First Line	:	3725 W 4100 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84120-5530
Country	:	US
Telephone Number	:	801-966-6681
Fax Number	:	801-966-6600

Provider Business Practice Location Address
First Line	:	3725 W 4100 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84120-5530
Country	:	US
Telephone Number	:	801-966-6681
Fax Number	:	801-966-6600

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT R TAYLOR
Credential	:	DMF
Telephone Number	:	801-966-6681

Provider Enumeration Date	:	08/15/2011
Last Update Date	:	08/15/2011

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Directions to “GRANGER ORTHODONTICS ” Practice Location

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