| Kids Town Pediatric Dentistry Of Syracuse | |
|
780 S 2000 W Suite #f-2 Syracuse UT 84075-9602 | |
| (801) 776-8176 | |
| (801) 774-9085 |
| Full Name | Kids Town Pediatric Dentistry Of Syracuse |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 780 S 2000 W, Syracuse, Utah |
| Authorized Official Name and Position | Brett Packham (MEMBER) |
| Authorized Official Contact | 8012173359 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kids Town Pediatric Dentistry Of Syracuse 780 S 2000 W Suite #f-2 Syracuse UT 84075-9602 Ph: (801) 776-8176 | Kids Town Pediatric Dentistry Of Syracuse 780 S 2000 W Suite #f-2 Syracuse UT 84075-9602 Ph: (801) 776-8176 |
| NPI Number | 1992179964 |
|---|---|
| Provider Enumeration Date | 11/13/2015 |
| Last Update Date | 11/13/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992179964 | NPI | - | NPPES |
| 1477728269 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 6362621-9922 (Utah) | Primary |
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