Provider Demographics
NPI:1639667801
Name:ST. GEORGE KIDS DENTAL AT SNOW CANYON
Entity Type:Organization
Organization Name:ST. GEORGE KIDS DENTAL AT SNOW CANYON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WESTON
Authorized Official - Last Name:HIGBEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:435-590-7014
Mailing Address - Street 1:1100 CANYON VIEW DR STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-5672
Mailing Address - Country:US
Mailing Address - Phone:435-673-3490
Mailing Address - Fax:435-627-9954
Practice Address - Street 1:1100 CANYON VIEW DR STE A
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:UT
Practice Address - Zip Code:84765-5672
Practice Address - Country:US
Practice Address - Phone:435-673-3490
Practice Address - Fax:435-627-9954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT89821231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty