Provider Demographics
NPI:1790796258
Name:SITTLER, EDWARD JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JAMES
Last Name:SITTLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 DEER MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5554
Mailing Address - Country:US
Mailing Address - Phone:801-602-6941
Mailing Address - Fax:
Practice Address - Street 1:14717 MINUTEMAN DR.
Practice Address - Street 2:UTAH DEPARTMENT OF CORRECTIONS-CLINICAL SERVICES
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020
Practice Address - Country:US
Practice Address - Phone:801-576-7107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT59894059921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist