Individual
DR. DUSTIN KEVIN ELLSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
291 S MAIN ST STE C, SMITHFIELD, UT 84335-1902
(435) 760-7823
Mailing address
395 E 1400 N STE B, LOGAN, UT 84341-7575
(435) 760-7823
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12885950-9922
UT
Other
Enumeration date
06/15/2022
Last updated
06/15/2022
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