Provider Demographics
NPI:1861226771
Name:COMPREHENSIVE SEDATION DENTAL
Entity type:Organization
Organization Name:COMPREHENSIVE SEDATION DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-960-6513
Mailing Address - Street 1:135 N 500 E
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-1571
Mailing Address - Country:US
Mailing Address - Phone:801-960-6513
Mailing Address - Fax:
Practice Address - Street 1:8706 S 700 E STE 203
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-1809
Practice Address - Country:US
Practice Address - Phone:801-871-9342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AION ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty