Organization
KIDS CREEK PED. DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL B BAILEY (OWNER)
(801) 417-8080
Entity
Organization
Contact information
Practice address
2964 W 4700 S STE 103, TAYLORSVILLE, UT 84129-2558
(801) 417-8080
Mailing address
2964 W 4700 S STE 103, TAYLORSVILLE, UT 84129-2558
(801) 417-8080
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
7693653
UT
Other
Enumeration date
04/10/2017
Last updated
04/10/2017
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