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General NPI Number Information
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NPI Number | 1609739713
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Entity Type | Organization
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Legal Business Name | RIDGE LINE DENTAL L.L.C.
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 2185 N 1700 W #202
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City | LAYTON
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State | UT
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Zip | 84041
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Country | US
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Telephone | 801-773-5460
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Fax |
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Provider Business Mailing Address
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Address Line | 2185 N 1700 W #202
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City | LAYTON
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State | UT
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Zip | 84041
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Country | US
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Telephone | 801-773-5460
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REVE WARNER CHASTON
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Credential | D.D.S.,M.S.D.
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Telephone | 801-773-5460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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