Provider Demographics
NPI:1700228541
Name:HALF DENTAL OGDEN
Entity Type:Organization
Organization Name:HALF DENTAL OGDEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAYSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-852-5252
Mailing Address - Street 1:2274 N WASHINGTON BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-7378
Mailing Address - Country:US
Mailing Address - Phone:801-852-5252
Mailing Address - Fax:801-855-7152
Practice Address - Street 1:2274 N WASHINGTON BLVD
Practice Address - Street 2:STE 202
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-7378
Practice Address - Country:US
Practice Address - Phone:801-852-5252
Practice Address - Fax:801-855-7152
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HALF DENTAL OGDEN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1905261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental