Provider Demographics
NPI:1689242307
Name:SONDRUP, CLIFFORD (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:
Last Name:SONDRUP
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 1:49 S 1200 E APT 4
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1649
Mailing Address - Country:US
Mailing Address - Phone:801-648-0503
Mailing Address - Fax:
Practice Address - Street 1:34 S 500 E STE 206
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1023
Practice Address - Country:US
Practice Address - Phone:801-648-0503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12333250-99231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice