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General NPI Number Information
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NPI Number | 1861929846
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Entity Type | Individual
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Provider Name | RAYMOND RUSSELL DURHAM DMD
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Gender | Male
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 03/13/2021
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Provider Practice Location Address
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Address Line | 991 SHEPARD LN STE 100
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City | FARMINGTON
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State | UT
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Zip | 84025-2973
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Country | US
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Telephone | 801-447-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 2116 SHARPSHOOTER DR
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City | FARMINGTON
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State | UT
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Zip | 84025-2688
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Country | US
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Telephone | 435-256-5062
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 10336372-9922
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License Number State | UT
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