Provider Demographics
NPI:1831758283
Name:DAVIDOV, MENAKHEM (DMD)
Entity type:Individual
Prefix:
First Name:MENAKHEM
Middle Name:
Last Name:DAVIDOV
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 1:11100 S RIVER HEIGHTS DR APT B227
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-6216
Mailing Address - Country:US
Mailing Address - Phone:347-556-6937
Mailing Address - Fax:
Practice Address - Street 1:3648 W 9800 S
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-3260
Practice Address - Country:US
Practice Address - Phone:801-260-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11285655-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice