SOUTH OGDEN PEDIATRIC DENTAL P.C. NPI 1104834191

NPI Information

SOUTH OGDEN PEDIATRIC DENTAL P.C. is a pediatric dentistry dentist in Washington Terrace, UT. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. SOUTH OGDEN PEDIATRIC DENTAL P.C. NPI is 1104834191. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

5275 S. ADAMS AVE.,
SUITE C
WASHINGTON TERRACE, UT
ZIP 84405
Phone: (801) 475-6433
Fax: (801) 334-8411

The provider's authorized official is M. Wade Rallison .
The authorized official title is Owner and has the following contact phone number (801) 475-6433.

The enumeration date for this NPI number is 8/4/2006 and was last updated on 6/21/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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