| Rose Park Pediatric Dentistry, Pc | |
|
55 N Redwood Rd Ste B Salt Lake City UT 84116-3174 | |
| (801) 519-2222 | |
| Not Available |
| Full Name | Rose Park Pediatric Dentistry, Pc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 55 N Redwood Rd Ste B, Salt Lake City, Utah |
| Authorized Official Name and Position | Richard Ryan Johansen (OWNER) |
| Authorized Official Contact | 8015192222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rose Park Pediatric Dentistry, Pc 55 N Redwood Rd Ste B Salt Lake City UT 84116-3174 Ph: (801) 519-2222 | Rose Park Pediatric Dentistry, Pc 55 N Redwood Rd Ste B Salt Lake City UT 84116-3174 Ph: (801) 519-2222 |
| NPI Number | 1831338623 |
|---|---|
| Provider Enumeration Date | 02/18/2009 |
| Last Update Date | 02/18/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831338623 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 49534949923 (Utah) | Primary |
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