1558553776 NPI number — A.F. FAMILY DENTAL, INC.

Table of content: MR. RICHARD SCOTT BAHNER MD (NPI 1407812068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558553776 NPI number — A.F. FAMILY DENTAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A.F. FAMILY DENTAL, INC.
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:
AMERICAN FORK FAMILY DENTAL, INC.
Provider Other Organization Name Type Code:
5
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:
1558553776
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 E 300 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMERICAN FORK
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84003-1790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-756-0933
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 E 300 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMERICAN FORK
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84003-1790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-756-0933
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TRACY
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
801-756-0933

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  145854-9922 , 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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