Provider Demographics
NPI:1619048816
Name:KWANT, JOHN WILLIAM III (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:KWANT
Suffix:III
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 1:1227 W 9000 S
Mailing Address - Street 2:SUITE E
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9001
Mailing Address - Country:US
Mailing Address - Phone:801-676-0839
Mailing Address - Fax:801-676-0840
Practice Address - Street 1:1227 W 9000 S
Practice Address - Street 2:SUITE E
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9001
Practice Address - Country:US
Practice Address - Phone:801-676-0839
Practice Address - Fax:801-676-0840
Is Sole Proprietor?:No
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT52430251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice