Individual
PAUL G. INNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1901 PROSPECTOR AVE, PARK CITY, UT 84060-7207
(435) 649-6332
(435) 649-3144
Mailing address
PO BOX 681179, PARK CITY, UT 84068-1179
(435) 649-6332
(435) 649-3144
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
144608-9922
UT
Other
Enumeration date
05/15/2007
Last updated
07/08/2007
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