Provider Demographics
NPI:1265267355
Name:RED CLIFF PEDIATRIC DENTAL
Entity type:Organization
Organization Name:RED CLIFF PEDIATRIC DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTI
Authorized Official - Middle Name:
Authorized Official - Last Name:FARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-215-9540
Mailing Address - Street 1:826 S 3000 E STE 1
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-1823
Mailing Address - Country:US
Mailing Address - Phone:435-628-0511
Mailing Address - Fax:
Practice Address - Street 1:826 S 3000 E STE 1
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-1823
Practice Address - Country:US
Practice Address - Phone:435-628-0511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-06
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty