Individual
HARLEY JO WHITESIDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
576 E HIGHWAY 138 STE 200, STANSBURY PARK, UT 84074-4028
(435) 728-0550
Mailing address
67 N TERRACE DR, CLEARFIELD, UT 84015-2235
(801) 549-8634
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
14226474-9926
UT
Other
Enumeration date
06/30/2025
Last updated
06/30/2025
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