Provider Demographics
NPI:1669634846
Name:CHILD, PAUL LORIN JR (DMD, CDT)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LORIN
Last Name:CHILD
Suffix:JR
Gender:M
Credentials:DMD, CDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10706 S RIVER FRONT PKWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3519
Mailing Address - Country:US
Mailing Address - Phone:801-252-1460
Mailing Address - Fax:
Practice Address - Street 1:10706 S RIVER FRONT PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3519
Practice Address - Country:US
Practice Address - Phone:801-252-1460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2015-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6940132-99221223P0700X
IL019.0290361223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics