Provider Demographics
NPI:1619734241
Name:CONE-BEAM CONSULTANTS
Entity Type:Organization
Organization Name:CONE-BEAM CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BLAIRE
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-200-9175
Mailing Address - Street 1:3240 W OXFORD LOOP
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GREEN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-6503
Mailing Address - Country:US
Mailing Address - Phone:801-200-9175
Mailing Address - Fax:
Practice Address - Street 1:3240 W OXFORD LOOP
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GREEN
Practice Address - State:UT
Practice Address - Zip Code:84050-6503
Practice Address - Country:US
Practice Address - Phone:801-200-9175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty