# SMALL SMILES PEDIATRIC DENTISTRY P.C.

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

## Provider details

- **NPI number:** 1922211523
- **Authorized official:** MELODY JEAN FRYER (OFFICE MANAGER)
- **Authorized official phone:** (435) 792-3033

## Contact information

- **Practice address:** 1300 N 200 E, SUITE 102, LOGAN, UT 84341-2398
- **Practice address phone:** (435) 792-3033
- **Practice address fax:** (435) 792-3233
- **Mailing address:** 1300 N 200 E, SUITE 102, LOGAN, UT 84341-2398
- **Mailing address phone:** (435) 792-3033
- **Mailing address fax:** (435) 792-3233

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 285140-9923 | UT | Yes |

## Other

- **Enumeration date:** 05/08/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 529376727002 | — | UT |