Provider Demographics
NPI:1922541507
Name:MOBILE DENTAL HYGIENE OF ST. GEORGE
Entity Type:Organization
Organization Name:MOBILE DENTAL HYGIENE OF ST. GEORGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:DANYELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:435-680-0517
Mailing Address - Street 1:2506 E WILDERNESS GATE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-2582
Mailing Address - Country:US
Mailing Address - Phone:435-680-0517
Mailing Address - Fax:
Practice Address - Street 1:2506 E WILDERNESS GATE DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-2582
Practice Address - Country:US
Practice Address - Phone:435-680-0517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT332958-9920124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty