Individual
DR. BROCK WILDE CASPERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
929 W SUNSET BLVD, ST GEORGE, UT 84770-4865
(435) 656-5900
Mailing address
929 W SUNSET BLVD, ST GEORGE, UT 84770-4865
(435) 656-5900
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8345061-9922
UT
Other
Enumeration date
10/15/2011
Last updated
07/02/2015
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