Provider Demographics
NPI:1891862991
Name:OAKRIDGE DENTAL
Entity Type:Organization
Organization Name:OAKRIDGE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-451-6222
Mailing Address - Street 1:1433 N 1075 W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2746
Mailing Address - Country:US
Mailing Address - Phone:801-451-6222
Mailing Address - Fax:801-451-6262
Practice Address - Street 1:1433 N 1075 W
Practice Address - Street 2:SUITE 100
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2746
Practice Address - Country:US
Practice Address - Phone:801-451-6222
Practice Address - Fax:801-451-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5338440-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty