Healthcare Provider Details

I. General information

NPI: 1114549573
Provider Name (Legal Business Name): RICHFIELD FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 N MAIN ST STE 1
RICHFIELD UT
84701-1893
US

IV. Provider business mailing address

820 N MAIN ST STE 1
RICHFIELD UT
84701-1893
US

V. Phone/Fax

Practice location:
  • Phone: 435-896-9696
  • Fax:
Mailing address:
  • Phone: 435-896-9696
  • Fax:

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: BENJAMIN BOWMAN
Title or Position: OWNER
Credential:
Phone: 405-326-8004