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NPI Code Detail

MEDICARE: DR. CLIFFORD SONDRUP DDS

MEDICARE: DR. CLIFFORD SONDRUP DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry12333250-9923UT

General Provider Information

NPI Number : 1689242307
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CLIFFORD SONDRUP DDS
Provider Business Mailing Address
First Line : 49 S 1200 E APT 4
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84102-1649
Country : US
Telephone Number : 801-648-0503
Fax Number :
Provider Business Practice Location Address
First Line : 34 S 500 E STE 202
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84102-1094
Country : US
Telephone Number : 801-648-0503
Fax Number : 385-301-5535
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2021
Last Update Date : 07/17/2025

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Directions to “ DR. CLIFFORD SONDRUP DDS” Practice Location

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