Individual
TAYLOR V PETTIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
167 E 200 N STE 3, LOGAN, UT 84321-4049
(435) 363-3584
Mailing address
197 EVERGREEN DR, IDAHO FALLS, ID 83401-2907
(208) 971-2125
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
14038757-9923
UT
Other
Enumeration date
06/25/2024
Last updated
07/02/2024
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