Organization
HERRIMAN PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES ODION DDS (OWNER)
(801) 877-5800
Entity
Organization
Contact information
Practice address
11996 S ANTHEM PARK BLVD # 101, HERRIMAN, UT 84096-5643
(801) 877-5800
(801) 907-7266
Mailing address
11996 S ANTHEM PARK BLVD # 101, HERRIMAN, UT 84096-5643
(801) 877-5800
(801) 907-7266
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
8858650
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
556752017001
—
UT
Enumeration date
07/29/2016
Last updated
07/29/2016
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