Provider Demographics
NPI:1457553745
Name:DANIEL S BETHERS DDS PC
Entity Type:Organization
Organization Name:DANIEL S BETHERS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BETHERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-674-7430
Mailing Address - Street 1:1224 S RIVER RD
Mailing Address - Street 2:BUILDING E SUITE 2
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8285
Mailing Address - Country:US
Mailing Address - Phone:435-674-7430
Mailing Address - Fax:435-652-9532
Practice Address - Street 1:1224 S RIVER RD
Practice Address - Street 2:BUILDING E SUITE 2
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8285
Practice Address - Country:US
Practice Address - Phone:435-674-7430
Practice Address - Fax:435-652-9532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5895914-99211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty