South Ogden Pediatric Dental P.c. | |
5275 S. Adams Ave., Suite C Washington Terrace UT 84405 | |
(801) 475-6433 | |
(801) 334-8411 |
Full Name | South Ogden Pediatric Dental P.c. |
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Speciality | Dentist - Pediatric Dentistry |
Location | 5275 S. Adams Ave.,, Washington Terrace, Utah |
Authorized Official Name and Position | M. Wade Rallison (OWNER) |
Authorized Official Contact | 8014756433 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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South Ogden Pediatric Dental P.c. 5275 S. Adams Ave., Suite C Suite #4 Washington Terrace UT 84405 Ph: (801) 475-6433 | South Ogden Pediatric Dental P.c. 5275 S. Adams Ave., Suite C Washington Terrace UT 84405 Ph: (801) 475-6433 |
NPI Number | 1104834191 |
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Provider Enumeration Date | 08/04/2006 |
Last Update Date | 06/21/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104834191 | NPI | - | NPPES |
518155919002 | Medicaid | UT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223P0221X | Dentist - Pediatric Dentistry | 5118697-9923 (Utah) | Primary |
Pleasant Valley Dental And Sleep Center Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 5742 Adams Ave Pkwy, Washington Terrace, UT 84405 Phone: 801-621-3383 |