Provider Demographics
NPI:1942412523
Name:POWELL, LLEWELLYN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LLEWELLYN
Middle Name:
Last Name:POWELL
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 1:10920 RIVER FRONT PKWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3538
Mailing Address - Country:US
Mailing Address - Phone:801-878-1418
Mailing Address - Fax:801-878-1334
Practice Address - Street 1:10920 RIVER FRONT PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3538
Practice Address - Country:US
Practice Address - Phone:801-878-1418
Practice Address - Fax:801-878-1334
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8019997-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice