# PEDIATRIC DENTAL PC

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

## Provider details

- **NPI number:** 1992880710
- **Authorized official:** DR. JOHN R. ANDERSON (OWNER)
- **Authorized official phone:** (801) 540-5081

## Contact information

- **Practice address:** 1401 N HIGHWAY 89, \#200, FARMINGTON, UT 84025-2745
- **Practice address phone:** (801) 447-5437
- **Practice address fax:** (801) 447-4685
- **Mailing address:** 1401 N HIGHWAY 89, \#200, FARMINGTON, UT 84025-2745
- **Mailing address phone:** (801) 447-5437
- **Mailing address fax:** (801) 447-4685

## Taxonomy

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

## Other

- **Enumeration date:** 10/27/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 528537398004 | — | UT |