Jon Ralph Chisholm, D.D.S
Individual provider Active NPI General Practice Dentistry · Santaquin, UT
NPI 1811065683 · NPPES record last updated Aug 3, 2010
Key facts
- NPI
- 1811065683
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 973419729921 (UT)
- Practice address
- 10 S 300 W
Santaquin, UT 84655-8147 - Phone
- (801) 754-0678
- Fax
- (801) 754-1157
- NPI assigned
- Dec 1, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 973419729921 | UT | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jon Chisholm Dentistry | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 973419729921 | UT | Yes |
Addresses
Primary practice location
10 S 300 W
Santaquin, UT 84655-8147
Mailing address
10 S 300 W
P.O Box 266
Santaquin, UT 84655-8147
Phone (801) 754-0678
Other providers in Santaquin, UT
- Holly Binks
- Wesley S Bott
- Irina M. Campbell
- Canyon View Medical Group
- Canyon View Medical Group LLC
- Joshua Richard Chisholm
- Nathan Richard Christensen
- Jessica Clegg
- Tonya Coates
- Copper Heights Wellness PLLC
All providers in Santaquin, UT · General Practice Dentistry in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.