MEDICARE: DAYBREAK PDC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223P0300X	Periodontics
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
3	122300000X	Dentist

General Provider Information

NPI Number	:	1699317685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAYBREAK PDC PLLC

Provider Business Mailing Address
First Line	:	PO BOX 970325
Second Line	:
City	:	OREM
State	:	UT
Zip	:	84097-0309
Country	:	US
Telephone Number	:	801-305-3460
Fax Number	:	801-335-6551

Provider Business Practice Location Address
First Line	:	4040 WEST DAYBREAK PKWY
Second Line	:	SUITE 103
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-1286
Country	:	US
Telephone Number	:	385-279-4334
Fax Number	:	385-212-3268

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	JACOB WARNER
Credential	:
Telephone Number	:	385-279-4334

Provider Enumeration Date	:	10/11/2019
Last Update Date	:	10/11/2019

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Directions to “DAYBREAK PDC PLLC ” Practice Location

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