Provider Demographics
NPI:1396465274
Name:HOUGH, FALENE ALICE (OMT)
Entity type:Individual
Prefix:
First Name:FALENE
Middle Name:ALICE
Last Name:HOUGH
Suffix:
Gender:F
Credentials:OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1367 E 1980 N
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2070
Mailing Address - Country:US
Mailing Address - Phone:435-374-3952
Mailing Address - Fax:
Practice Address - Street 1:1367 E 1980 N
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2070
Practice Address - Country:US
Practice Address - Phone:435-374-3952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
UT7827160-9920124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No124Q00000XDental ProvidersDental Hygienist