| Herriman Pediatric Dentistry | |
|
11996 S Anthem Park Blvd # 101 Herriman UT 84096-5643 | |
| (801) 877-5800 | |
| (801) 907-7266 |
| Full Name | Herriman Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 11996 S Anthem Park Blvd # 101, Herriman, Utah |
| Authorized Official Name and Position | Charles Odion (OWNER) |
| Authorized Official Contact | 8018775800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Herriman Pediatric Dentistry 11996 S Anthem Park Blvd # 101 Herriman UT 84096-5643 Ph: (801) 877-5800 | Herriman Pediatric Dentistry 11996 S Anthem Park Blvd # 101 Herriman UT 84096-5643 Ph: (801) 877-5800 |
| NPI Number | 1376096966 |
|---|---|
| Provider Enumeration Date | 07/29/2016 |
| Last Update Date | 07/29/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376096966 | NPI | - | NPPES |
| 556752017001 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 8858650 (Utah) | Primary |
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