Healthcare Provider Details

I. General information

NPI: 1740341007
Provider Name (Legal Business Name): DAREN FRED GEHRING DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 N 200 E STE 100
LOGAN UT
84341-3141
US

IV. Provider business mailing address

3297 N 1450 E
NORTH LOGAN UT
84341-6756
US

V. Phone/Fax

Practice location:
  • Phone: 435-752-4330
  • Fax: 435-752-6330
Mailing address:
  • Phone: 435-753-3574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2849469923
License Number StateUT

VII. Legacy identifiers

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

# 1
Identifier119125000
Identifier TypeMEDICAID
Identifier StateWY
Identifier Issuer
# 2
Identifier806491800
Identifier TypeMEDICAID
Identifier StateID
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: