Individual
DR. MARK THEODORE ENDRIZZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3105 W 5400 S, TAYLORSVILLE, UT 84118-2200
(801) 969-6236
Mailing address
3105 W 5400 S, TAYLORSVILLE, UT 84118-2200
(801) 969-6236
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D12090
MN
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
6671559-9921
UT
Other
Enumeration date
11/05/2005
Last updated
12/31/2008
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