Provider Demographics
NPI:1174688378
Name:POND, W. HENRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:W.
Middle Name:HENRY
Last Name:POND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 E VINE ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5549
Mailing Address - Country:US
Mailing Address - Phone:801-262-8728
Mailing Address - Fax:801-685-2701
Practice Address - Street 1:688 E VINE ST
Practice Address - Street 2:SUITE 16
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5549
Practice Address - Country:US
Practice Address - Phone:801-262-8728
Practice Address - Fax:801-685-2701
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT143527-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice