Healthcare Provider Details

I. General information

NPI: 1023952546
Provider Name (Legal Business Name): SAMANTHA LYNN GUDEAHN-ALLEANO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA LYNN PRINCE

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E MAIN ST STE 201
MIDWAY UT
84049-6817
US

IV. Provider business mailing address

210 E MAIN ST STE 201
MIDWAY UT
84049-6817
US

V. Phone/Fax

Practice location:
  • Phone: 435-654-2822
  • Fax:
Mailing address:
  • Phone: 435-654-2822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9642039-9923
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: