Provider Demographics
NPI:1053312595
Name:WINGROVE, DANIELLE PAIGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:PAIGE
Last Name:WINGROVE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:PAIGE
Other - Last Name:STIEGEMEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1060 FREMONT RD
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-1413
Mailing Address - Country:US
Mailing Address - Phone:319-290-7255
Mailing Address - Fax:
Practice Address - Street 1:530 S WAKARA WAY
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1213
Practice Address - Country:US
Practice Address - Phone:801-587-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082951223E0200X, 1223G0001X
OH30-0224941223E0200X
ORD109111223E0200X
UT12600945-99211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice