Provider Demographics
NPI:1124510532
Name:LINSLEY, ERIC DANIELS (DDS)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:DANIELS
Last Name:LINSLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4762 S 1800 W APT 5
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-3610
Mailing Address - Country:US
Mailing Address - Phone:801-690-4161
Mailing Address - Fax:
Practice Address - Street 1:2201 N WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-7296
Practice Address - Country:US
Practice Address - Phone:801-528-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10844338-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice