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General NPI Number Information
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NPI Number | 1922892124
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Entity Type | Individual
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Provider Name | CYNTHIA ANNE MARIN RDH
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Gender | Female
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Dates
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Enumeration Date | 04/04/2025
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 7127 S 400 W
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City | MIDVALE
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State | UT
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Zip | 84047-1065
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Country | US
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Telephone | 801-701-3368
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Fax |
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Provider Business Mailing Address
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Address Line | 14327 S FRIENDSHIP DR
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City | HERRIMAN
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State | UT
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Zip | 84096-1906
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Country | US
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Telephone | 423-902-3835
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 10913590-9922
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License Number State | UT
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