Provider Demographics
NPI:1063759694
Name:HALF DENTAL ST. GEORGE
Entity type:Organization
Organization Name:HALF DENTAL ST. GEORGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-656-3868
Mailing Address - Street 1:350 E 600 S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3904
Mailing Address - Country:US
Mailing Address - Phone:435-656-3868
Mailing Address - Fax:435-656-3870
Practice Address - Street 1:350 E 600 S
Practice Address - Street 2:SUITE 1
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3904
Practice Address - Country:US
Practice Address - Phone:435-656-3868
Practice Address - Fax:435-656-3870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT347527-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1417014762OtherNPI
UT1750422804OtherNPI