MEDICARE: DR. DAREN FRED GEHRING 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
1	1223P0221X	Pediatric Dentistry	2849469923	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740341007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAREN FRED GEHRING DDS

Provider Business Mailing Address
First Line	:	3297 N 1450 E
Second Line	:
City	:	NORTH LOGAN
State	:	UT
Zip	:	84341-6756
Country	:	US
Telephone Number	:	435-753-3574
Fax Number	:

Provider Business Practice Location Address
First Line	:	1624 N 200 E STE 100
Second Line	:
City	:	LOGAN
State	:	UT
Zip	:	84341-3141
Country	:	US
Telephone Number	:	435-752-4330
Fax Number	:	435-752-6330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	04/07/2016

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