Individual
KIRT DALLAS LONGFELLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1737 N 2000 W STE G, CLINTON, UT 84015-8215
(801) 771-8000
Mailing address
1737 N 2000 W STE G, CLINTON, UT 84015-8215
(801) 771-8000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12949750-9922
UT
Other
Enumeration date
08/04/2022
Last updated
08/04/2022
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