Provider Demographics
NPI:1669734141
Name:RICHINS, BRETT C
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:C
Last Name:RICHINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 W 5600 S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-9161
Mailing Address - Country:US
Mailing Address - Phone:801-440-4222
Mailing Address - Fax:
Practice Address - Street 1:3401 N CENTER ST STE 125
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-7500
Practice Address - Country:US
Practice Address - Phone:801-901-8802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8329970-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist