South Ogden Pediatric Dental P.c.
NPI #1104834191 in Washington Terrace, Utah
Provider Information
- NPI Number
- 1104834191
- Entity Type
- Organization
- Organization Name
- South Ogden Pediatric Dental P.c.
- Primary Specialty
- Dentist - Pediatric Dentistry
- Enumeration Date
- Aug 4, 2006
- Last Updated
- Jun 21, 2011
Practice Location
- Address
- 5275 S. ADAMS AVE.,
- Address 2
- SUITE C
- State
- Utah
- ZIP Code
- 84405
- Phone
- (801) 475-6433
Authorized Official
- Name
- M. WADE RALLISON, DDS
- Title
- OWNER
- Phone
- (801) 475-6433
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - Pediatric Dentistry — Pediatric Dentistry |
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