Healthcare Provider Details

I. General information

NPI: 1831156371
Provider Name (Legal Business Name): RICHARD W ELGGREN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6287 S REDWOOD RD #203
TAYLORSVILLE UT
84123
US

IV. Provider business mailing address

6287 S REDWOOD RD #203
TAYLORSVILLE UT
84123
US

V. Phone/Fax

Practice location:
  • Phone: 801-266-7393
  • Fax: 801-266-0212
Mailing address:
  • Phone: 801-266-7393
  • Fax: 801-266-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number133458
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: