Provider Demographics
NPI:1578229233
Name:ALLEN-TAINTOR DERMATOLOGY LLC
Entity type:Organization
Organization Name:ALLEN-TAINTOR DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-627-0515
Mailing Address - Street 1:3860 JACKSON AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1979
Mailing Address - Country:US
Mailing Address - Phone:801-627-0515
Mailing Address - Fax:801-627-0517
Practice Address - Street 1:3860 JACKSON AVE STE 2
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1979
Practice Address - Country:US
Practice Address - Phone:801-627-0515
Practice Address - Fax:801-627-0517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty