Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 5171989 | UT |
NPI | 1053537571 |
---|---|
Provider Name | Dr. Ryan Frederick Vanmoorlehem |
First Address | Spanish Fork, UT 84660-1241 |
Second Address | Spanish Fork, UT 84660-1241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 21/06/2010 |