Provider Demographics
NPI:1780499418
Name:HILDALE PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:HILDALE PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:435-531-9238
Mailing Address - Street 1:1185 W UTAH AVE # 201
Mailing Address - Street 2:
Mailing Address - City:HILDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84784-7711
Mailing Address - Country:US
Mailing Address - Phone:435-874-2783
Mailing Address - Fax:
Practice Address - Street 1:1185 W UTAH AVE # 201
Practice Address - Street 2:
Practice Address - City:HILDALE
Practice Address - State:UT
Practice Address - Zip Code:84784-7711
Practice Address - Country:US
Practice Address - Phone:435-874-2783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-10
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty