Healthcare Provider Details

I. General information

NPI: 1225602972
Provider Name (Legal Business Name): STERLING ENDODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E 200 N STE G
LOGAN UT
84321-4036
US

IV. Provider business mailing address

150 E 200 N STE G
LOGAN UT
84321-4036
US

V. Phone/Fax

Practice location:
  • Phone: 435-753-7668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KIP STERLING
Title or Position: OWNER
Credential: DDS, MS
Phone: 801-473-1252