MEDICARE: MS. KAROL ANGELA ALDRICH RDH

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	124Q00000X	Dental Hygienist	117929-9920	UT

General Provider Information

NPI Number	:	1336665132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAROL ANGELA ALDRICH RDH

Provider Business Mailing Address
First Line	:	1657 E SPYGLASS HILL DR
Second Line	:
City	:	DRAPER
State	:	UT
Zip	:	84020-5604
Country	:	US
Telephone Number	:	801-556-7526
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 E 3700 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-4634
Country	:	US
Telephone Number	:	385-646-4894
Fax Number	:

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

Provider Enumeration Date	:	08/14/2017
Last Update Date	:	08/14/2017

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