Organization
WISDOM TEETH OF SOUTHERN UTAH
Active
Parent organization
ST. GEORGE KIDS DENTAL AT SNOW CANYON
Other names
Wisdom Teeth of Southern Utah
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. GEORGE KIDS DENTAL AT SNOW CANYON
Authorized official
DAYNE JENSEN DMD MD (OWNER)
(435) 673-3490
Entity
Organization
Contact information
Practice address
446 S MALL DR STE 100, ST GEORGE, UT 84790-4944
(435) 673-3490
(435) 627-9954
Mailing address
446 S MALL DR STE 100, ST GEORGE, UT 84790-4944
(435) 673-3490
(435) 627-9954
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1881926509
NPI
—
Enumeration date
01/23/2019
Last updated
01/23/2019
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