# PEDIATRIC DENTAL & ORTHODONTICS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184706491
- **Authorized official:** DR. JOHN R. ANDERSON DDS (OWNER)
- **Authorized official phone:** (801) 540-5081

## Contact information

- **Practice address:** 3485 W 4800 S, ROY, UT 84067-9429
- **Practice address phone:** (801) 774-5437
- **Practice address fax:** (801) 774-9440
- **Mailing address:** 3485 W 4800 S, ROY, UT 84067-9429
- **Mailing address phone:** (801) 774-5437
- **Mailing address fax:** (801) 774-9440

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 341292 | UT | Yes |

## Other

- **Enumeration date:** 10/19/2006
- **Last updated:** 12/20/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 528537398001 | — | UT |