Provider Demographics
NPI:1922275577
Name:R JEFF EASTON DMD PC
Entity Type:Organization
Organization Name:R JEFF EASTON DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JEFF
Authorized Official - Last Name:EASTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-571-3400
Mailing Address - Street 1:850 E 9400 S
Mailing Address - Street 2:STE 202
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3632
Mailing Address - Country:US
Mailing Address - Phone:801-571-3400
Mailing Address - Fax:801-572-7773
Practice Address - Street 1:850 E 9400 S
Practice Address - Street 2:STE 202
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3632
Practice Address - Country:US
Practice Address - Phone:801-571-3400
Practice Address - Fax:801-572-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT56666129922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty