Healthcare Provider Details

I. General information

NPI: 1275148744
Provider Name (Legal Business Name): ZACHARY RICHARD DIAMOND DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3454 S 4800 W
WEST VALLEY UT
84120-1705
US

IV. Provider business mailing address

3454 S 4800 W
WEST VALLEY UT
84120-1705
US

V. Phone/Fax

Practice location:
  • Phone: 801-969-3025
  • Fax:
Mailing address:
  • Phone: 801-969-3025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number108234
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00204527
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14289327-9923
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: