Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 30022222 | OH |
Y | 1223P0221X | Pediatric Dentist | 6329558-9922 | UT |
N | 1223P0221X | Pediatric Dentist | S6-85 | NV |
NPI | 1063596104 |
---|---|
Provider Name | Dr. Jeremy Scholzen |
First Address | Hurricane, UT 84737-2423 |
Second Address | Hurricane, UT 84737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 09/08/2007 |