Provider Demographics
NPI:1073321204
Name:SILVER RIDGE DENTAL CARE
Entity type:Organization
Organization Name:SILVER RIDGE DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DEVRIES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-694-3106
Mailing Address - Street 1:1291 W 12600 S STE 104
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7130
Mailing Address - Country:US
Mailing Address - Phone:801-254-4161
Mailing Address - Fax:
Practice Address - Street 1:1291 W 12600 S STE 104
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7130
Practice Address - Country:US
Practice Address - Phone:801-254-4161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty