Provider Demographics
NPI:1447652896
Name:CARDON ENDODONTICS PC
Entity type:Organization
Organization Name:CARDON ENDODONTICS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-504-6295
Mailing Address - Street 1:41 E 500 N
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1515
Mailing Address - Country:US
Mailing Address - Phone:801-504-6295
Mailing Address - Fax:801-504-6548
Practice Address - Street 1:41 E 500 N
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1515
Practice Address - Country:US
Practice Address - Phone:801-504-6295
Practice Address - Fax:801-504-6548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT90748171223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty