Provider Demographics
NPI:1598256026
Name:BRONS-PICHE, EMILY RAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:RAE
Last Name:BRONS-PICHE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8706 S 700 E STE 100
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-1808
Mailing Address - Country:US
Mailing Address - Phone:015-724-4048
Mailing Address - Fax:801-572-4405
Practice Address - Street 1:8706 S 700 E STE 100
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-1808
Practice Address - Country:US
Practice Address - Phone:801-255-3351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010225691223G0001X
UT12720110-9923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice