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General NPI Number Information
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NPI Number | 1053312595
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Entity Type | Individual
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Provider Name | DANIELLE PAIGE WINGROVE DDS
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Gender | Female
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 04/14/2022
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Provider Practice Location Address
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Address Line | 530 S WAKARA WAY
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City | SALT LAKE CITY
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State | UT
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Zip | 84108-1213
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Country | US
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Telephone | 801-587-2202
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Fax |
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Provider Business Mailing Address
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Address Line | 1060 FREMONT RD
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City | BOUNTIFUL
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State | UT
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Zip | 84010-1413
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Country | US
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Telephone | 319-290-7255
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 08295
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 30-022494
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D10911
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 08295
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License Number State | IA
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Taxonomy #5
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 12600945-9921
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License Number State | UT
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