Provider Demographics
NPI:1326396383
Name:PRINCE, STEVEN GREGORY (DMD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:GREGORY
Last Name:PRINCE
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 1:10454 N EDINBURGH DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9584
Mailing Address - Country:US
Mailing Address - Phone:480-291-2318
Mailing Address - Fax:
Practice Address - Street 1:36 S 1100 E STE A
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2837
Practice Address - Country:US
Practice Address - Phone:801-756-6246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-24
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008513122300000X
UT12446733-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist