Provider Demographics
NPI:1376745661
Name:BETHERS, DANIEL S (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:BETHERS
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 1:1765 W 70 SOUTH CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5034
Mailing Address - Country:US
Mailing Address - Phone:435-674-1538
Mailing Address - Fax:435-669-6275
Practice Address - Street 1:1224 S RIVER RD
Practice Address - Street 2:BUILDING E SUITE 2
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8285
Practice Address - Country:US
Practice Address - Phone:435-674-7430
Practice Address - Fax:435-669-6275
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5895914-99211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics