# HERRIMAN PEDIATRIC DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376096966
- **Authorized official:** CHARLES ODION DDS (OWNER)
- **Authorized official phone:** (801) 877-5800

## Contact information

- **Practice address:** 11996 S ANTHEM PARK BLVD \# 101, HERRIMAN, UT 84096-5643
- **Practice address phone:** (801) 877-5800
- **Practice address fax:** (801) 907-7266
- **Mailing address:** 11996 S ANTHEM PARK BLVD \# 101, HERRIMAN, UT 84096-5643
- **Mailing address phone:** (801) 877-5800
- **Mailing address fax:** (801) 907-7266

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 8858650 | UT | Yes |

## Other

- **Enumeration date:** 07/29/2016
- **Last updated:** 07/29/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 556752017001 | — | UT |