Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 136618-9921 | UT |
NPI | 1063591907 |
---|---|
Provider Name | Dr. David Newell Remington |
First Address | Tooele, UT 84074-1776 |
Second Address | Tooele, UT 84074-1776 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 08/07/2007 |