Provider Demographics
NPI:1487428975
Name:SOUTH VALLEY PEDIATRIC DENTISTRY PLLC
Entity type:Organization
Organization Name:SOUTH VALLEY PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHAMBERLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-489-1301
Mailing Address - Street 1:688 W 400 S STE 101
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-3127
Mailing Address - Country:US
Mailing Address - Phone:801-489-1301
Mailing Address - Fax:801-491-4851
Practice Address - Street 1:688 W 400 S STE 101
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-3127
Practice Address - Country:US
Practice Address - Phone:801-489-1301
Practice Address - Fax:801-491-4851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty