Provider Demographics
NPI:1063672590
Name:GIAUQUE, KENT A (DDS)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:A
Last Name:GIAUQUE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 E 3900 S
Mailing Address - Street 2:# 210
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1474
Mailing Address - Country:US
Mailing Address - Phone:801-272-4466
Mailing Address - Fax:
Practice Address - Street 1:1345 E 3900 S
Practice Address - Street 2:# 210
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1474
Practice Address - Country:US
Practice Address - Phone:801-272-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT20781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice