Provider Demographics
NPI:1154573129
Name:CEDAR VIEW PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:CEDAR VIEW PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ALBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:435-586-8188
Mailing Address - Street 1:1251 N. NORTHFIELD RD. STE 201
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721
Mailing Address - Country:US
Mailing Address - Phone:435-586-8188
Mailing Address - Fax:435-867-1362
Practice Address - Street 1:1251 N. NORTHFIELD RD. STE 201
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721
Practice Address - Country:US
Practice Address - Phone:435-586-8188
Practice Address - Fax:435-867-1362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529416124001Medicaid