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General NPI Number Information
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NPI Number | 1306145784
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Entity Type | Organization
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Legal Business Name | AFFORDABLE DENTURES RIVERDALE P.C.
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Dates
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Enumeration Date | 03/24/2011
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Last Update Date | 03/24/2011
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Provider Practice Location Address
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Address Line | 4035 RIVERDALE RD SUITE C
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City | RIVERDALE
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State | UT
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Zip | 84405-1517
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Country | US
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Telephone | 801-334-0515
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Fax |
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Provider Business Mailing Address
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Address Line | 4035 C RIVERDALE RD
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City | RIVERDALE
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State | UT
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Zip | 84405
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Country | US
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Telephone | 801-334-0515
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIANA HALL
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Credential | DDS
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Telephone | 801-334-0515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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