Provider Demographics
NPI:1780979138
Name:DR. JEFFREY A IVERSON
Entity type:Organization
Organization Name:DR. JEFFREY A IVERSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:IVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MS
Authorized Official - Phone:801-571-9664
Mailing Address - Street 1:850 E 9400 S STE 201
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-4118
Mailing Address - Country:US
Mailing Address - Phone:801-571-9664
Mailing Address - Fax:801-571-9662
Practice Address - Street 1:850 E 9400 S STE 201
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-4118
Practice Address - Country:US
Practice Address - Phone:801-571-9664
Practice Address - Fax:801-571-9662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty