# BRIGHAM YOUNG UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BYU Dance
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790175628
- **Authorized official:** MOUZON BASS III (AGENT)
- **Authorized official phone:** (972) 367-4845

## Contact information

- **Practice address:** 173 RICHARDS BUILDING, DANCE DEPARTMENT, PROVO, UT 84602-2000
- **Practice address phone:** (972) 367-4845
- **Practice address fax:** (972) 367-3452
- **Mailing address:** 5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
- **Mailing address phone:** (972) 367-4845
- **Mailing address fax:** (972) 367-3452

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/30/2015
- **Last updated:** 05/11/2017