Healthcare Provider Details

I. General information

NPI: 1336665132
Provider Name (Legal Business Name): KAROL ANGELA ALDRICH RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 08/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E 3700 S
SALT LAKE CITY UT
84115-4634
US

IV. Provider business mailing address

1657 E SPYGLASS HILL DR
DRAPER UT
84020-5604
US

V. Phone/Fax

Practice location:
  • Phone: 385-646-4894
  • Fax:
Mailing address:
  • Phone: 801-556-7526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number117929-9920
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: