Provider Demographics
NPI:1730658071
Name:KAYSVILLE FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:KAYSVILLE FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIPPEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-546-2439
Mailing Address - Street 1:47 E CRESTWOOD RD STE 5
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1445
Mailing Address - Country:US
Mailing Address - Phone:801-546-2439
Mailing Address - Fax:801-546-0759
Practice Address - Street 1:47 E CRESTWOOD RD STE 5
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1445
Practice Address - Country:US
Practice Address - Phone:801-546-2439
Practice Address - Fax:801-546-0759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental