# CHILDREN'S DENTISTRY

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1235505587
- **Authorized official:** MARK LYMAN NELSON DDS (DENTIST/OWNER)
- **Authorized official phone:** (801) 295-8322

## Contact information

- **Practice address:** 1551 RENAISSANCE TOWNE DR, STE 540, BOUNTIFUL, UT 84010-7667
- **Practice address phone:** (801) 295-8322
- **Mailing address:** 1551 RENAISSANCE TOWNE DR, STE 540, BOUNTIFUL, UT 84010-7667
- **Mailing address phone:** (801) 295-8322

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 141802 | UT | Yes |

## Other

- **Enumeration date:** 08/20/2015
- **Last updated:** 08/20/2015