Provider Demographics
NPI:1821093048
Name:GIFFORD, DONALD RAY (DDS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:RAY
Last Name:GIFFORD
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 1:2230 N UNIVERSITY PKWY
Mailing Address - Street 2:8-B
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-1509
Mailing Address - Country:US
Mailing Address - Phone:801-377-6400
Mailing Address - Fax:801-377-6450
Practice Address - Street 1:2230 N UNIVERSITY PKWY
Practice Address - Street 2:8-B
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-1509
Practice Address - Country:US
Practice Address - Phone:801-377-6400
Practice Address - Fax:801-377-6450
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT25601223P0221X
TX290221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry