Healthcare Provider Details

I. General information

NPI: 1881317535
Provider Name (Legal Business Name): REDWOOD DENTAL PDC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 N SPRING CREEK PKWY STE D
PROVIDENCE UT
84332-9875
US

IV. Provider business mailing address

PO BOX 970652
OREM UT
84097-0652
US

V. Phone/Fax

Practice location:
  • Phone: 435-755-6562
  • Fax: 435-755-6797
Mailing address:
  • Phone: 435-755-6562
  • Fax: 435-755-6797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALICIA LARSEN
Title or Position: REVENUE CYCLE MANAGEMENT
Credential:
Phone: 801-305-3460