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General NPI Number Information
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NPI Number | 1689120891
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Entity Type | Individual
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Provider Name | CIERRA DIAMSE DMD
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Gender | Female
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 718 W COLISEUM WAY
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City | MIDVALE
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State | UT
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Zip | 84047-4867
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Country | US
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Telephone | 801-590-8694
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Fax | 801-290-2761
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Provider Business Mailing Address
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Address Line | 718 W COLISEUM WAY
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City | MIDVALE
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State | UT
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Zip | 84047-4867
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Country | US
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Telephone | 801-590-8694
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Fax | 801-290-2761
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9821483-9922
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License Number State | UT
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