Provider Demographics
NPI:1780179416
Name:TO, ERIC GENE (DMD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:GENE
Last Name:TO
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 1:399 W 700 N
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-1333
Mailing Address - Country:US
Mailing Address - Phone:801-856-1560
Mailing Address - Fax:
Practice Address - Street 1:3940 N TRAVERSE MOUNTAIN BLVD # 102
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4914
Practice Address - Country:US
Practice Address - Phone:801-852-8211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7345300-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist