Provider Demographics
NPI:1700167095
Name:COUSER ORTHODONTICS, LLC
Entity Type:Organization
Organization Name:COUSER ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARISON
Authorized Official - Middle Name:DAN
Authorized Official - Last Name:COUSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:801-544-9191
Mailing Address - Street 1:250 W 200 N STE 2
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-6701
Mailing Address - Country:US
Mailing Address - Phone:801-544-9191
Mailing Address - Fax:801-719-6241
Practice Address - Street 1:250 W 200 N STE 2
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-6701
Practice Address - Country:US
Practice Address - Phone:801-544-9191
Practice Address - Fax:801-719-6241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT66988741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty