MEDICARE: SAMUEL BYBEE

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	14283275-9926	UT

General Provider Information

NPI Number	:	1306773262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL BYBEE

Provider Business Mailing Address
First Line	:	1653 OLYMPIA CT NW
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97304-2094
Country	:	US
Telephone Number	:	503-409-5810
Fax Number	:

Provider Business Practice Location Address
First Line	:	13686 S REDWOOD RD
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-5905
Country	:	US
Telephone Number	:	503-409-5810
Fax Number	:

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

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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Directions to “ SAMUEL BYBEE ” Practice Location

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