Healthcare Provider Details

I. General information

NPI: 1558265389
Provider Name (Legal Business Name): WILLDEN DENTAL UT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10654 S RIVER HEIGHTS DR STE 330
SOUTH JORDAN UT
84095-5544
US

IV. Provider business mailing address

10654 S RIVER HEIGHTS DR STE 330
SOUTH JORDAN UT
84095-5544
US

V. Phone/Fax

Practice location:
  • Phone: 801-214-0445
  • Fax:
Mailing address:
  • Phone: 801-214-0445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ERIC JAMES ROMAN
Title or Position: MEMBER
Credential: DDS
Phone: 919-225-0613