Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 1356769922 | UT |
NPI | 1003009150 |
---|---|
Provider Name | Irvin Lee Ence |
First Address | St George, UT 84770 |
Second Address | St George, UT 84770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2007 |
Last Update Date | 22/08/2007 |