Provider Demographics
NPI:1295478352
Name:UTLEY, COLTON SAMUEL (DMD)
Entity type:Individual
Prefix:
First Name:COLTON
Middle Name:SAMUEL
Last Name:UTLEY
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 1:3197 TRUMAN DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-5352
Mailing Address - Country:US
Mailing Address - Phone:435-632-5552
Mailing Address - Fax:
Practice Address - Street 1:444 E TABERNACLE ST
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3270
Practice Address - Country:US
Practice Address - Phone:435-628-9099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12791488-99231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice