Provider Demographics
NPI:1477270171
Name:RESTFULLY
Entity Type:Organization
Organization Name:RESTFULLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-610-5708
Mailing Address - Street 1:4344 STAFFORD CT
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5559
Mailing Address - Country:US
Mailing Address - Phone:702-610-5708
Mailing Address - Fax:
Practice Address - Street 1:476 W 800 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-3728
Practice Address - Country:US
Practice Address - Phone:801-221-7615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESTFULLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty