Individual
DR. IRENE ISAZA BEVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
3785 W 10400 S, SOUTH JORDAN, UT 84095
(801) 253-2249
Mailing address
2212 E OAK LEAF WAY, SANDY, UT 84092-5688
(321) 948-8374
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11324979-9922
UT
Other
Enumeration date
06/24/2019
Last updated
06/24/2019
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