Provider Demographics
NPI:1407922461
Name:GEDDES, DERALD WILFORD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DERALD
Middle Name:WILFORD
Last Name:GEDDES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 33RD ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1378
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1220 33RD ST
Practice Address - Street 2:SUITE D
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1378
Practice Address - Country:US
Practice Address - Phone:801-394-5554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1444371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice