Provider Demographics
NPI:1922607589
Name:TRENTON L OVERALL, INC
Entity Type:Organization
Organization Name:TRENTON L OVERALL, INC
Other - Org Name:DESERT RIDGE NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRENTON
Authorized Official - Middle Name:L
Authorized Official - Last Name:OVERALL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:435-218-6958
Mailing Address - Street 1:295 S 1470 E STE 301
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-1762
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:295 S 1470 E STE 301
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-1762
Practice Address - Country:US
Practice Address - Phone:435-775-2015
Practice Address - Fax:435-775-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty