Provider Demographics
NPI:1043845365
Name:C & B FAMILY PRACTICE
Entity Type:Organization
Organization Name:C & B FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CINDIE
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:DODENBIER
Authorized Official - Suffix:
Authorized Official - Credentials:CFNPC
Authorized Official - Phone:801-452-1066
Mailing Address - Street 1:PO BOX 332
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:UT
Mailing Address - Zip Code:84001-0332
Mailing Address - Country:US
Mailing Address - Phone:801-725-6872
Mailing Address - Fax:435-454-3200
Practice Address - Street 1:4601 N 16750 W
Practice Address - Street 2:
Practice Address - City:ALTONAH
Practice Address - State:UT
Practice Address - Zip Code:84002-0332
Practice Address - Country:US
Practice Address - Phone:801-725-6872
Practice Address - Fax:435-454-3209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health