Provider Demographics
NPI:1427089804
Name:RADMALL, RICH S (DDS)
Entity type:Individual
Prefix:DR
First Name:RICH
Middle Name:S
Last Name:RADMALL
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 1:5685 S 1475 E STE A1
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4598
Mailing Address - Country:US
Mailing Address - Phone:801-479-8680
Mailing Address - Fax:
Practice Address - Street 1:5685 S 1475 E STE A1
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4598
Practice Address - Country:US
Practice Address - Phone:801-479-8680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14327199221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice