Provider Demographics
NPI:1588964340
Name:PAYSON FAMILY AND COSMETIC DENTISTRY, LLC
Entity type:Organization
Organization Name:PAYSON FAMILY AND COSMETIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CAHOON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MBA
Authorized Official - Phone:801-560-9757
Mailing Address - Street 1:2754 SAINT MARYS WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2040
Mailing Address - Country:US
Mailing Address - Phone:801-560-9757
Mailing Address - Fax:801-303-7055
Practice Address - Street 1:107 S 500 W
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2029
Practice Address - Country:US
Practice Address - Phone:801-465-7966
Practice Address - Fax:801-303-7055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1399149922261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental