Individual
JACOB FONCEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-3900
Mailing address
99 E PRINCETON DR APT F312, SANDY, UT 84070-1278
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
14017196-9926
UT
Other
Enumeration date
06/06/2024
Last updated
06/06/2024
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