Provider Demographics
NPI:1982831020
Name:REDD, MARK H (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:REDD
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 1:1245 CAPITOL ST
Mailing Address - Street 2:121-N
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-2847
Mailing Address - Country:US
Mailing Address - Phone:801-621-8000
Mailing Address - Fax:801-621-8001
Practice Address - Street 1:1245 CAPITOL ST
Practice Address - Street 2:121-N
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-2847
Practice Address - Country:US
Practice Address - Phone:801-621-8000
Practice Address - Fax:801-621-8001
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT73624871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice