CLW DDS PLLC

Dentist · Eden, UT

Organization Active NPI

NPI number 1871626630

Practice location

2640 N Highway 162
Eden, UT 84310-9745
Phone
(801) 745-1100

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NPI record

NPI
1871626630
Entity type
Organization (Type 2)
Enumeration date
March 13, 2007
Last updated
November 6, 2014
Organization subpart
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Dentist Primary 122300000X 8926074-9922 UT

Mailing address

PO Box 805
Eden, UT 84310-0805

Authorized official

Name
Chad Wagstaff, DDS
Title
President
Phone
(801) 745-1100

About CLW DDS PLLC

CLW DDS PLLC is a healthcare organization registered in the NPI registry with the primary taxonomy Dentist (code 122300000X). The practice location is 2640 N Highway 162, Eden, UT 84310-9745. The NPI number 1871626630 was assigned on March 13, 2007 and the record was last updated on November 6, 2014.

CLW DDS PLLC lists a license in the registry: #8926074-9922 (UT) for Dentist. License numbers are self-reported to NPPES; verify them with the state licensing board.

The authorized official for this organization is Chad Wagstaff, DDS, President.

Frequently asked questions

What is the NPI number of CLW DDS PLLC?

The NPI number is 1871626630.

What is the phone number of CLW DDS PLLC?

The phone number listed for the practice location is (801) 745-1100.

Where is CLW DDS PLLC located?

2640 N Highway 162, Eden, UT 84310-9745.

What is the taxonomy code for CLW DDS PLLC?

The primary taxonomy code is 122300000X – Dentist.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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