Individual
JUAN DIAZ DE LEON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2520 N UNIVERSITY AVE STE 101, PROVO, UT 84604-6081
(801) 426-6255
Mailing address
7101 N MOUNTAIN FIELD DR, EAGLE MOUNTAIN, UT 84005-6551
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8743606-9922
UT
Other
Enumeration date
05/24/2018
Last updated
05/24/2018
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