1205098324 NPI number — TODD C. LISTON DDS, MS, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205098324 NPI number — TODD C. LISTON DDS, MS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TODD C. LISTON DDS, MS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205098324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2297 N HILL FIELD RD
Provider Second Line Business Mailing Address:
BUILDING A, SUITE 105
Provider Business Mailing Address City Name:
LAYTON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84041-6920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-779-0506
Provider Business Mailing Address Fax Number:
801-779-4344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
469 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
BOUNTIFUL
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84010-4900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-299-8531
Provider Business Practice Location Address Fax Number:
801-299-9667
Provider Enumeration Date:
06/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LISTON
Authorized Official First Name:
TODD
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
ORAL AND MAXILLOFACIAL SURGEON
Authorized Official Telephone Number:
801-779-0506

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  260605 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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