Individual
DR. MARK HENRY HABERMEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4115 RIVERDALE RD STE B, RIVERDALE, UT 84405-3509
(801) 940-5555
Mailing address
4115 RIVERDALE RD STE B, RIVERDALE, UT 84405-3509
(801) 940-5555
(384) 206-8383
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9231171-9921
UT
1223G0001X
General Practice Dentistry
26994
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
508064
DENTICAL
CA
01
—
9231171-9921
STATE OF UTAH DEPARTMENT OF COMMERCE
UT
Enumeration date
08/02/2006
Last updated
12/08/2015
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