Healthcare Provider Details

I. General information

NPI: 1851359897
Provider Name (Legal Business Name): RONALD JAMES SCOVILLE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 N MAIN ST SUITE 101
CLEARFIELD UT
84015-3222
US

IV. Provider business mailing address

1063 W 4000 N
PLEASANT VIEW UT
84414-3328
US

V. Phone/Fax

Practice location:
  • Phone: 801-776-6441
  • Fax: 801-776-8428
Mailing address:
  • Phone: 801-528-8915
  • Fax: 801-776-8428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5918254
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: