Provider Demographics
NPI:1629037379
Name:WILDING, ALAN DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:DAVID
Last Name:WILDING
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 1:224 W 575 S
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-7774
Mailing Address - Country:US
Mailing Address - Phone:801-546-3899
Mailing Address - Fax:
Practice Address - Street 1:1747 HERITAGE LN
Practice Address - Street 2:SUITE A-1
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-8552
Practice Address - Country:US
Practice Address - Phone:801-525-1415
Practice Address - Fax:801-525-0583
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT51498571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice