Healthcare Provider Details

I. General information

NPI: 1578755948
Provider Name (Legal Business Name): DARRELL OSTERHOUDT D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DARRELL OSTERHOUDT D.M.D., M.S.

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9217 S REDWOOD RD SUITE C
WEST JORDAN UT
84088-5826
US

IV. Provider business mailing address

9217 S REDWOOD RD SUITE C
WEST JORDAN UT
84088-5826
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 Code1223D0001X
TaxonomyPublic Health Dentistry
License Number5138167-9922
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberH06158
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: