Organization
LIDDELL FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN C LIDDELL DMD (PARTNER)
(801) 733-0406
Entity
Organization
Contact information
Practice address
702 E SOUTH TEMPLE STE 209, SALT LAKE CITY, UT 84102-1795
(801) 359-8282
Mailing address
702 E SOUTH TEMPLE STE 209, SALT LAKE CITY, UT 84102-1795
(801) 359-8282
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
22-13695-9922
UT
1223G0001X
General Practice Dentistry
Primary
512081-9922
UT
Other
Enumeration date
05/18/2007
Last updated
02/26/2008
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