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NPI Code Detail

MEDICARE: CRAIG S CHURCH DDS FAMILY DENTISTRY

MEDICARE: CRAIG S CHURCH DDS FAMILY DENTISTRY
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
1122300000XDentist

General Provider Information

NPI Number : 1477962009
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRAIG S CHURCH DDS FAMILY DENTISTRY
Provider Business Mailing Address
First Line : 85 N CENTER ST
Second Line :
City : DELTA
State : UT
Zip : 84624-8430
Country : US
Telephone Number : 435-864-4623
Fax Number :
Provider Business Practice Location Address
First Line : 85 N CENTER ST
Second Line :
City : DELTA
State : UT
Zip : 84624-8430
Country : US
Telephone Number : 435-864-4623
Fax Number :
Authorized Official
Title or Position : OWNER/DENTIST
Name : DR. CRAIG S CHURCH
Credential : DDS
Telephone Number : 435-864-4623
Provider Enumeration Date : 08/07/2014
Last Update Date : 08/07/2014

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Directions to “CRAIG S CHURCH DDS FAMILY DENTISTRY ” Practice Location

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