Provider Demographics
NPI:1639226095
Name:RADMALL, VAL L (DDS)
Entity Type:Individual
Prefix:DR
First Name:VAL
Middle Name:L
Last Name:RADMALL
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 1:5300 S ADAMS
Mailing Address - Street 2:10
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6955
Mailing Address - Country:US
Mailing Address - Phone:801-476-8709
Mailing Address - Fax:801-476-9794
Practice Address - Street 1:5300 S ADAMS
Practice Address - Street 2:10
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6955
Practice Address - Country:US
Practice Address - Phone:801-476-9709
Practice Address - Fax:801-476-9794
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT881439989922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist