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General NPI Number Information
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NPI Number | 1023537156
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Entity Type | Individual
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Provider Name | BRENDA FUELL RDH
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Gender | Female
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Dates
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Enumeration Date | 09/09/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 12959 SOUTH PICKET FENCE LANE
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City | RIVERTON
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State | UT
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Zip | 84065
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Country | US
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Telephone | 801-712-1154
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Fax |
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Provider Business Mailing Address
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Address Line | 12959 S PICKET FENCE LN
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City | RIVERTON
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State | UT
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Zip | 84065-6933
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Country | US
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Telephone | 801-712-1154
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 5328674-9920
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License Number State | UT
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