South Ogden Pediatric Dental P.c.

NPI 1104834191 - Dentist - 1223P0221X

NPI Details
NPI 1104834191
Enumeration Date 08/04/2006
Last Updated 06/21/2011
Entity Type Healthcare Provider
Active Over 10 years ago
Authorized Information
Name M. WADE M.
Position OWNER
Phone (801) 475-6433
Fax (801) 334-8411
Practice Location
5275 S. ADAMS AVE.,
SUITE C
WASHINGTON TERRACE UT, 84405, US
Phone (801) 475-6433
Fax (801) 334-8411
Business Location
5275 S. ADAMS AVE.,
SUITE C SUITE #4
WASHINGTON TERRACE UT, 84405, US
Phone (801) 475-6433
Fax (801) 334-8411
Toxanomy
Taxonomy Code 1223P0221X
License State Utah
License Number 5118697-9923
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According to our database, South Ogden Pediatric Dental P.c. NPI is 1104834191, taxonomy code is 1223P0221X and license number is 5118697-9923, license state is located at Utah. South Ogden Pediatric Dental P.c. physically located at 5275 S. Adams Ave.,, Washington Terrace UT, 84405. NPI Number 1033115704 has the healthcare provider type.

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1104834191 NPI number is provided on an as is basis without warranty of any kind. 1104834191 is maintained by the National Plan & Provider Enumeration System. The contents of South Ogden Pediatric Dental P.c. are for informational purposes only.