Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 9017911-9924 | UT |
NPI | 1093093312 |
---|---|
Provider Name | Dr. Braden Cordell Atkins |
First Address | Centerville, UT 84014-3148 |
Second Address | West Valley City, UT 84120-6250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2011 |
Last Update Date | 05/04/2021 |