Provider Demographics
NPI:1598035172
Name:ROMNEY PEDIATRIC DENTAL, PLLC
Entity Type:Organization
Organization Name:ROMNEY PEDIATRIC DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:L. CLARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:307-362-3125
Mailing Address - Street 1:525 E 100 S STE 430
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2074
Mailing Address - Country:US
Mailing Address - Phone:307-362-3125
Mailing Address - Fax:801-328-3054
Practice Address - Street 1:525 E 100 S STE 430
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84102-2074
Practice Address - Country:US
Practice Address - Phone:801-532-1402
Practice Address - Fax:801-328-3054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1598924078OtherINDIVIDUAL NPI