Provider Demographics
NPI:1659433803
Name:PUGH, BYRON CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:CHARLES
Last Name:PUGH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:B.
Other - Middle Name:CHARLES
Other - Last Name:PUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-0548
Mailing Address - Country:US
Mailing Address - Phone:801-254-1278
Mailing Address - Fax:
Practice Address - Street 1:12694 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-6605
Practice Address - Country:US
Practice Address - Phone:801-254-1278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT140202-8903122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist