Provider Demographics
NPI:1265037014
Name:K B DENTISTRY
Entity Type:Organization
Organization Name:K B DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:W
Authorized Official - Last Name:DIMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-255-3578
Mailing Address - Street 1:204 EAST FORT UNION BLVD, SUITE 101
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047
Mailing Address - Country:US
Mailing Address - Phone:801-255-3578
Mailing Address - Fax:801-210-7628
Practice Address - Street 1:204 EAST FORT UNION BLVD, SUITE 101
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047
Practice Address - Country:US
Practice Address - Phone:801-255-3578
Practice Address - Fax:801-210-7628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty