Provider Demographics
NPI:1770634594
Name:FROST, RON A (DMD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:A
Last Name:FROST
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 N HILL FIELD RD
Mailing Address - Street 2:#110
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-2192
Mailing Address - Country:US
Mailing Address - Phone:801-774-8190
Mailing Address - Fax:801-774-8191
Practice Address - Street 1:1868 N HILL FIELD RD
Practice Address - Street 2:#110
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-2192
Practice Address - Country:US
Practice Address - Phone:801-774-8190
Practice Address - Fax:801-774-8191
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1401761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT228094OtherTRIGON
UT591983OtherUNITED CONCORDIA
UT0005695276OtherAETNA
UT72191-1OtherUNITED HEALTHCARE