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6973 S 4800 W Suite C West Jordan UT 84084-7927 | |
| (801) 840-4833 | |
| (801) 969-2628 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 6973 S 4800 W, West Jordan, Utah |
| Authorized Official Name and Position | John R Ayre (OWNER) |
| Authorized Official Contact | 8018404833 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6973 S 4800 W Suite C West Jordan UT 84084-7927 Ph: (801) 840-4833 | 6973 S 4800 W Suite C West Jordan UT 84084-7927 Ph: (801) 840-4833 |
| NPI Number | 1386956233 |
|---|---|
| Provider Enumeration Date | 07/08/2010 |
| Last Update Date | 07/08/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386956233 | NPI | - | NPPES |
| 519024150002 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 374350 (Utah) | Primary |
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