Organization
KIDS TOWN PEDIATRIC DENTISTRY OF SYRACUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT PACKHAM DDS (MEMBER)
(801) 217-3359
Entity
Organization
Contact information
Practice address
780 S 2000 W, SUITE #F-2, SYRACUSE, UT 84075-9602
(801) 776-8176
(801) 774-9085
Mailing address
780 S 2000 W, SUITE #F-2, SYRACUSE, UT 84075-9602
(801) 776-8176
(801) 774-9085
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
6362621-9922
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477728269
—
UT
Enumeration date
11/13/2015
Last updated
11/13/2015
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