MEDICARE: ROY PEDIATRIC DENTISTRY LLC DBA WEE CARE PEDIATRIC DENTISTRY AND 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
2	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1407720899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROY PEDIATRIC DENTISTRY LLC DBA WEE CARE PEDIATRIC DENTISTRY AND ORTHODONTICS

Provider Business Mailing Address
First Line	:	5682 S 3500 W UNIT A
Second Line	:
City	:	ROY
State	:	UT
Zip	:	84067-9108
Country	:	US
Telephone Number	:	801-773-8644
Fax Number	:	801-773-9828

Provider Business Practice Location Address
First Line	:	5682 S 3500 W UNIT A
Second Line	:
City	:	ROY
State	:	UT
Zip	:	84067-9108
Country	:	US
Telephone Number	:	801-773-8644
Fax Number	:	801-773-9828

Authorized Official
Title or Position	:	DENTAL PROVIDER
Name	:	CHARLES ODION
Credential	:	DDS
Telephone Number	:	801-254-9700

Provider Enumeration Date	:	09/30/2025
Last Update Date	:	09/30/2025

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