Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 6679426-9922 | UT |
NPI | 1104003102 |
---|---|
Provider Name | Ryan Schofield Wing |
First Address | Spanish Fork, UT 84660-3002 |
Second Address | Spanish Fork, UT 84660-3002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2008 |
Last Update Date | 09/12/2021 |