Provider Demographics
NPI:1184474975
Name:ST. GEORGE KIDS DENTAL DOWNTOWN PLLC
Entity type:Organization
Organization Name:ST. GEORGE KIDS DENTAL DOWNTOWN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:GRAFF
Authorized Official - Last Name:PRYOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-329-4580
Mailing Address - Street 1:446 S MALL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4944
Mailing Address - Country:US
Mailing Address - Phone:435-673-3490
Mailing Address - Fax:435-627-9954
Practice Address - Street 1:754 S MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5506
Practice Address - Country:US
Practice Address - Phone:435-673-9922
Practice Address - Fax:435-673-9411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty