Organization
GRANTSVILLE DENTAL CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH GLEN KILLIAN D.D.S. (GENERAL DENTIST)
(435) 884-3476
Entity
Organization
Contact information
Practice address
14 N HALE ST, GRANTSVILLE, UT 84029-9315
(435) 884-3476
(435) 884-6790
Mailing address
PO BOX 706, 14 N. HALE STREET, GRANTSVILLE, UT 84029-0706
(435) 884-3478
(435) 884-6790
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
135097
UT
Other
Enumeration date
11/01/2006
Last updated
08/22/2020
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