Organization
PEDIATRIC DENTAL & ORTHODONTICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN R. ANDERSON DDS (OWNER)
(801) 540-5081
Entity
Organization
Contact information
Practice address
3485 W 4800 S, ROY, UT 84067-9429
(801) 774-5437
(801) 774-9440
Mailing address
3485 W 4800 S, ROY, UT 84067-9429
(801) 774-5437
(801) 774-9440
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
341292
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528537398001
—
UT
Enumeration date
10/19/2006
Last updated
12/20/2007
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