| 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. |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| 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 |