Organization Name: | PEDIATRIC DENTAL & ORTHODONTICS PC |
NPI Number: | 1184706491 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN R. ANDERSON (OWNER) |
Mailing Address: | 3485 W 4800 S Roy |
State: | UT US |
Postal Code: | 840679429 |
Phone Number: | 8017745437 |
Fax Number: | 8017749440 |
NPI Enumeration Date: | 10/19/2006 |
NPI Last Update Date: | 12/20/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | 341292 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |