Organization
PEDIATRIC DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN R. ANDERSON (OWNER)
(801) 540-5081
Entity
Organization
Contact information
Practice address
1401 N HIGHWAY 89, #200, FARMINGTON, UT 84025-2745
(801) 447-5437
(801) 447-4685
Mailing address
1401 N HIGHWAY 89, #200, FARMINGTON, UT 84025-2745
(801) 447-5437
(801) 447-4685
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
341292
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528537398004
—
UT
Enumeration date
10/27/2006
Last updated
08/22/2020
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