Organization
CUSTOM ORTHODONTICS
Active
Organization
CUSTOM ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADY M THOMSON DDS (OWNER/ORTHODONTIST)
(435) 752-1320
Entity
Organization
Contact information
Practice address
255 N 3000 W STE B, WEST POINT, UT 84015-7493
(801) 825-2208
Mailing address
255 N 3000 W STE B, WEST POINT, UT 84015-7493
(801) 825-2208
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801085063
—
UT
05
—
1912998725
—
UT
Enumeration date
11/09/2016
Last updated
11/09/2016
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