MEDICARE: DR. DANIELLE PAIGE WINGROVE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	08295	IA
2	1223E0200X	Endodontics	30-022494	OH
3	1223E0200X	Endodontics	D10911	OR
4	1223G0001X	General Practice Dentistry	08295	IA
5	1223E0200X	Endodontics	12600945-9921	UT

General Provider Information

NPI Number	:	1053312595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIELLE PAIGE WINGROVE DDS

Provider Business Mailing Address
First Line	:	1060 FREMONT RD
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84010-1413
Country	:	US
Telephone Number	:	319-290-7255
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 S WAKARA WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1213
Country	:	US
Telephone Number	:	801-587-2202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	04/14/2022

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