Healthcare Provider Details

I. General information

NPI: 1558903617
Provider Name (Legal Business Name): NATALIE LINARES RDH,BSDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S 200 E STE 250
SALT LAKE CITY UT
84111-3846
US

IV. Provider business mailing address

6069 S EAGLE NEST DR
SALT LAKE CITY UT
84123-7647
US

V. Phone/Fax

Practice location:
  • Phone: 801-359-2256
  • Fax:
Mailing address:
  • Phone: 801-244-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number9791978-9920
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: