Provider Demographics
NPI:1366096208
Name:RASK, HAILEE (DDS)
Entity type:Individual
Prefix:
First Name:HAILEE
Middle Name:
Last Name:RASK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 E CLAYBOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4032
Mailing Address - Country:US
Mailing Address - Phone:985-507-3055
Mailing Address - Fax:
Practice Address - Street 1:1555 E STRATFORD AVE STE 400
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3692
Practice Address - Country:US
Practice Address - Phone:385-500-7082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11344038-99211223X0400X
CODEN.002057811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty