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Organization
STANSBURY PARK PEDIATRIC DENTISTRY
Active
Organization
STANSBURY PARK PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALISHA SHIGLEY (OFFICE MANAGER)
(435) 580-8800
Entity
Organization
Contact information
Practice address
263 COUNTRY CLB STE 102, STANSBURY PARK, UT 84074-9602
(435) 580-8800
Mailing address
11996 S ANTHEM PARK BLVD STE 102, HERRIMAN, UT 84096-5643
(435) 580-8800
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
NULL
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275821415
NPI
UT
01
—
1346761152
NPI
UT
01
—
1811237076
NPI
UT
Enumeration date
10/02/2019
Last updated
10/02/2019
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