Provider Demographics
NPI:1194710681
Name:FENTON, ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:FENTON
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 1:155 S. 100 W.
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004
Mailing Address - Country:US
Mailing Address - Phone:801-756-9779
Mailing Address - Fax:
Practice Address - Street 1:75 W MAIN STREET CT STE 200
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-5602
Practice Address - Country:US
Practice Address - Phone:801-756-9779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT472535099211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics