Healthcare Provider Details

I. General information

NPI: 1881744951
Provider Name (Legal Business Name): DR. DARRELL L OSTERHOUDT & ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9217 REDWOOD RD STE C
WEST JORDAN UT
84088-5827
US

IV. Provider business mailing address

9217 REDWOOD RD STE C
WEST JORDAN UT
84088-5827
US

V. Phone/Fax

Practice location:
  • Phone: 801-568-0172
  • Fax: 801-568-3932
Mailing address:
  • Phone: 801-568-0172
  • Fax: 801-568-3932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRENDA SHELTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 801-568-0172