Provider Demographics
NPI:1710909155
Name:RICHARDS, DARELL G (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARELL
Middle Name:G
Last Name:RICHARDS
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 1:2160 E 4500 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4011
Mailing Address - Country:US
Mailing Address - Phone:801-278-4477
Mailing Address - Fax:801-278-4478
Practice Address - Street 1:2160 E 4500 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4011
Practice Address - Country:US
Practice Address - Phone:801-278-4477
Practice Address - Fax:801-278-4478
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1343461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice