Organization
SCHWEPPE PEDIATRIC DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATHEW D SCHWEPPE DDS (OWNER)
(801) 479-9220
Entity
Organization
Contact information
Practice address
5685 S 1475 E STE 3A, SOUTH OGDEN, UT 84403-4598
(801) 479-9220
(801) 479-0837
Mailing address
5685 S 1475 E STE 3A, SOUTH OGDEN, UT 84403-4598
(801) 479-9220
(801) 479-0837
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1141007-00
—
WY
05
—
517747532013
—
UT
Enumeration date
06/04/2019
Last updated
06/11/2019
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