Provider Demographics
NPI:1881019453
Name:ALL VALLEY DENTAL
Entity Type:Organization
Organization Name:ALL VALLEY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEGG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-277-8222
Mailing Address - Street 1:1377 E 3900 S STE 101
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1489
Mailing Address - Country:US
Mailing Address - Phone:801-277-8222
Mailing Address - Fax:801-277-7139
Practice Address - Street 1:1377 E 3900 S
Practice Address - Street 2:STE101
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1489
Practice Address - Country:US
Practice Address - Phone:801-277-8222
Practice Address - Fax:801-277-7139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty