Provider Demographics
NPI:1124477146
Name:RIDGE VIEW DENTAL, LLC
Entity type:Organization
Organization Name:RIDGE VIEW DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-334-9444
Mailing Address - Street 1:1186 E 4600 S
Mailing Address - Street 2:410
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4332
Mailing Address - Country:US
Mailing Address - Phone:801-334-9444
Mailing Address - Fax:
Practice Address - Street 1:1186 E 4600 S
Practice Address - Street 2:410
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4332
Practice Address - Country:US
Practice Address - Phone:801-334-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8698145-99221223G0001X
UT6267384-99221223G0001X
UT9032036-9920124Q00000X
UT119249-9920124Q00000X
UT8290111-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty