Provider Demographics
NPI:1548611866
Name:ENGAR, KIMBERLY JOHNSON (DMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOHNSON
Last Name:ENGAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3564 S 7200 W STE B
Mailing Address - Street 2:
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-3507
Mailing Address - Country:US
Mailing Address - Phone:801-250-1717
Mailing Address - Fax:
Practice Address - Street 1:3564 S 7200 W STE B
Practice Address - Street 2:
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044-3507
Practice Address - Country:US
Practice Address - Phone:801-250-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT345009-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist