Provider Demographics
NPI:1548330004
Name:FERRELL, ROBERT WADE (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WADE
Last Name:FERRELL
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 E SKYLINE DR
Mailing Address - Street 2:SUITE #300
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4846
Mailing Address - Country:US
Mailing Address - Phone:801-334-9258
Mailing Address - Fax:801-334-9273
Practice Address - Street 1:1508 E SKYLINE DR
Practice Address - Street 2:SUITE #300
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4846
Practice Address - Country:US
Practice Address - Phone:801-334-9258
Practice Address - Fax:801-334-9273
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3507031223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics