Healthcare Provider Details

I. General information

NPI: 1376197533
Provider Name (Legal Business Name): RICHARD BRADY PERDUE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 E MURRAY HOLLADAY RD
HOLLADAY UT
84117-5598
US

IV. Provider business mailing address

2110 E MURRAY HOLLADAY RD
HOLLADAY UT
84117-5598
US

V. Phone/Fax

Practice location:
  • Phone: 801-277-1916
  • Fax:
Mailing address:
  • Phone: 801-277-1916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD1247
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7576259-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: