NPI 1255294765 · live from the CMS NPI Registry
104 West Dental LLC
Dentist, General Practice in Brigham City, UT. National Provider Identifier 1255294765, active.
NPI record
| NPI | 1255294765 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dentist, General Practice 1223G0001X |
| Practice location | 104 W 200 S, Brigham City, UT 84302 |
| Practice phone | 435-734-2394 |
| Enumerated | December 3, 2025 |
| Last updated | December 3, 2025 |
| Authorized official | Daniel Nelson, Member |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, General Practice primary | 1223G0001X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.