Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 5939868 | UT |
NPI | 1043247554 |
---|---|
Provider Name | Dr. Branton J Richter |
First Address | Orem, UT 84097-4219 |
Second Address | Lehi, UT 84043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 08/07/2007 |