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General NPI Number Information
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NPI Number | 1689159147
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Entity Type | Organization
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Legal Business Name | STATION PARK DENTAL
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Dates
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Enumeration Date | 10/01/2018
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 1169 W CLARK LANE STE 101
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City | FARMINGTON
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State | UT
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Zip | 84025-2993
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Country | US
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Telephone | 801-797-0068
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Fax | 801-260-2110
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Provider Business Mailing Address
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Address Line | 1169 W CLARK LANE STE 101
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City | FARMINGTON
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State | UT
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Zip | 84025-2993
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Country | US
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Telephone | 801-797-0068
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Fax | 801-260-2110
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | RYAN BLAINE ALLEN
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Credential | DDS
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Telephone | 801-797-0068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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