MEDICARE: LIONIZE PLLC

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	261QD0000X	Dental Clinic/Center	344866-9922	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326201088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIONIZE PLLC

Provider Business Mailing Address
First Line	:	2074 S ARABIAN WAY
Second Line	:
City	:	WASHINGTON
State	:	UT
Zip	:	84780-8301
Country	:	US
Telephone Number	:	435-275-5000
Fax Number	:	888-935-3494

Provider Business Practice Location Address
First Line	:	2074 S ARABIAN WAY
Second Line	:
City	:	WASHINGTON
State	:	UT
Zip	:	84780-8301
Country	:	US
Telephone Number	:	435-275-5000
Fax Number	:	888-935-3494

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. SHANE TRENT TAYLOR
Credential	:	DDS
Telephone Number	:	435-275-5000

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	02/29/2012

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Directions to “LIONIZE PLLC ” Practice Location

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