MEDICARE: MOUNTAIN VIEW PEDIATRIC 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
1	261QD0000X	Dental Clinic/Center	5776592-9923	UT

General Provider Information

NPI Number	:	1578878443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN VIEW PEDIATRIC DENTISTRY

Provider Business Mailing Address
First Line	:	2719 N HIGHWAY 89
Second Line	:	STE 200
City	:	PLEASANT VIEW
State	:	UT
Zip	:	84404-6256
Country	:	US
Telephone Number	:	801-737-5437
Fax Number	:	801-737-5452

Provider Business Practice Location Address
First Line	:	2719 N HIGHWAY 89
Second Line	:	STE 200
City	:	PLEASANT VIEW
State	:	UT
Zip	:	84404-6256
Country	:	US
Telephone Number	:	801-737-5437
Fax Number	:	801-737-5452

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. CAMERON QUAYLE
Credential	:	DDS
Telephone Number	:	801-737-5437

Provider Enumeration Date	:	08/16/2010
Last Update Date	:	08/16/2010

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