Provider Demographics
NPI:1912671694
Name:GIFFORD, KATIE LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:LEE
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 N CENTER ST STE 125
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7500
Mailing Address - Country:US
Mailing Address - Phone:801-901-8802
Mailing Address - Fax:
Practice Address - Street 1:3401 N CENTER ST STE 125
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-7500
Practice Address - Country:US
Practice Address - Phone:801-901-8802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12333059-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice