Organization
REDWOOD PERIODONTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMY DWIGHT MANWARING DMD, MS (OWNER)
(801) 293-8833
Entity
Organization
Contact information
Practice address
6287 S REDWOOD RD STE 102, SALT LAKE CITY, UT 84123-6653
(801) 293-8833
(801) 293-8844
Mailing address
6287 S REDWOOD RD STE 102, SALT LAKE CITY, UT 84123-6653
(801) 293-8833
(801) 293-8844
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
56827969922
UT
Other
Enumeration date
03/21/2007
Last updated
07/23/2008
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