Provider Demographics
NPI:1306920590
Name:POWELL, DAVID B (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:POWELL
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 1:7478 S. CAMPUS VIEW DR.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084
Mailing Address - Country:US
Mailing Address - Phone:801-280-6911
Mailing Address - Fax:801-280-6955
Practice Address - Street 1:7478 CAMPUS VIEW DR
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-1966
Practice Address - Country:US
Practice Address - Phone:801-280-6911
Practice Address - Fax:801-280-6955
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT344165-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice