Provider Demographics
NPI:1740235035
Name:CHENEY, JESS C (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESS
Middle Name:C
Last Name:CHENEY
Suffix:
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 1:2040 E 4800 S
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5185
Mailing Address - Country:US
Mailing Address - Phone:801-278-7100
Mailing Address - Fax:801-278-1697
Practice Address - Street 1:2040 E 4800 S
Practice Address - Street 2:SUITE 208
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-5185
Practice Address - Country:US
Practice Address - Phone:801-278-7100
Practice Address - Fax:801-278-1697
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT141777-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice