Ryder A.T. Waldrond, DDS
Individual provider Active NPI Dentist · Sunset, UT
NPI 1245575554 · NPPES record last updated Nov 28, 2012
Key facts
- NPI
- 1245575554
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 5382340-9922 (UT)
- Practice address
- 170 W 1800 N
Sunset, UT 84015-2734 - Phone
- (801) 773-1533
- Fax
- (801) 773-1551
- NPI assigned
- Nov 28, 2012
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5382340-9922 | UT | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Convenient Dental Care | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5382340-9922 | UT | Yes |
Addresses
Primary practice location
170 W 1800 N
Sunset, UT 84015-2734
Mailing address
170 W 1800 N
Sunset, UT 84015-2734
Phone (801) 773-1533
Other providers in Sunset, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 28, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.