Provider Demographics
NPI:1841729027
Name:NYBO, JUSTIN JAY (DDS)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:JAY
Last Name:NYBO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-3339
Mailing Address - Country:US
Mailing Address - Phone:801-444-9911
Mailing Address - Fax:801-544-2255
Practice Address - Street 1:525 N FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-3339
Practice Address - Country:US
Practice Address - Phone:801-444-9911
Practice Address - Fax:801-544-2255
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10387202-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10387202-9922OtherSTATE LICENSE
UT10387202-9922OtherSTATE LICENSE