Provider Demographics
NPI:1346731122
Name:ZAGOREC, JOHN TYLER (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TYLER
Last Name:ZAGOREC
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 E DOWNINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3735
Mailing Address - Country:US
Mailing Address - Phone:801-652-7379
Mailing Address - Fax:
Practice Address - Street 1:3785 W 10400 S STE 103
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-5649
Practice Address - Country:US
Practice Address - Phone:801-253-2249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200254281223G0001X
UT8264015-99261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice