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General NPI Number Information
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NPI Number | 1700228541
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Entity Type | Organization
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Legal Business Name | HALF DENTAL OGDEN
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 2274 N WASHINGTON BLVD STE 202
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City | NORTH OGDEN
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State | UT
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Zip | 84414-7378
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Country | US
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Telephone | 801-852-5252
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Fax | 801-855-7152
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Provider Business Mailing Address
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Address Line | 2274 N WASHINGTON BLVD STE 202
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City | NORTH OGDEN
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State | UT
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Zip | 84414-7378
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Country | US
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Telephone | 801-852-5252
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Fax | 801-855-7152
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHAYSE MYERS
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Credential |
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Telephone | 801-852-5252
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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 | 1905
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License Number State | UT
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