Provider Demographics
NPI:1790110732
Name:CALL, NATHAN RUSSELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:RUSSELL
Last Name:CALL
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 1:1251 NORTHFIELD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-8623
Mailing Address - Country:US
Mailing Address - Phone:435-609-0885
Mailing Address - Fax:
Practice Address - Street 1:1251 NORTHFIELD RD STE 201
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-8623
Practice Address - Country:US
Practice Address - Phone:435-609-0885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9922122300000X
UT5865630-99241223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentist