Individual
DR. PRISCILA FABIANA PETRY BAUTISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
168 E 5900 S STE C103, MURRAY, UT 84107-7262
(801) 875-0370
Mailing address
11777 S AUTUMN RIDGE CV, SANDY, UT 84092-7345
(954) 397-4102
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12448109-9923
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/16/2019
Last updated
12/22/2022
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