Provider Demographics
NPI:1952429060
Name:SALMON, BRAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:
Last Name:SALMON
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 1:1086 NORTH FAIRFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040
Mailing Address - Country:US
Mailing Address - Phone:801-547-8880
Mailing Address - Fax:801-547-8911
Practice Address - Street 1:1086 NORTH FAIRFIELD ROAD
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040
Practice Address - Country:US
Practice Address - Phone:801-547-8880
Practice Address - Fax:801-547-8911
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14292699221223G0001X
UT1182359920124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No124Q00000XDental ProvidersDental Hygienist