Provider Demographics
NPI:1619354271
Name:REDWOOD PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:REDWOOD PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ODION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-281-8881
Mailing Address - Street 1:6287 S REDWOOD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-6655
Mailing Address - Country:US
Mailing Address - Phone:801-281-8881
Mailing Address - Fax:801-281-8883
Practice Address - Street 1:6287 S REDWOOD RD STE 201
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-6655
Practice Address - Country:US
Practice Address - Phone:801-281-8881
Practice Address - Fax:801-281-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT260205-99231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty