Provider Demographics
NPI:1326201088
Name:LIONIZE PLLC
Entity Type:Organization
Organization Name:LIONIZE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:TRENT
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-275-5000
Mailing Address - Street 1:2074 S ARABIAN WAY
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-8301
Mailing Address - Country:US
Mailing Address - Phone:435-275-5000
Mailing Address - Fax:888-935-3494
Practice Address - Street 1:2074 S ARABIAN WAY
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-8301
Practice Address - Country:US
Practice Address - Phone:435-275-5000
Practice Address - Fax:888-935-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT344866-9922261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529292691015Medicaid