Healthcare Provider Details

I. General information

NPI: 1043416019
Provider Name (Legal Business Name): AARIC JOHN ALLRED D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E MAIN ST SUITE G
GRANTSVILLE UT
84029
US

IV. Provider business mailing address

76 S CENTER ST
GRANTSVILLE UT
84029-9734
US

V. Phone/Fax

Practice location:
  • Phone: 435-884-3088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6629003-9922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: