IndividualActive
Chad Wagstaff, DDS
NPI 1730212564 · General Practice Dentistry · Eden, UT
Provider details
- NPI number
- 1730212564
- Entity type
- Individual
- Primary specialty
- General Practice DentistryDental Providers
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- No
- License
- 019-025276 (IL)
Specialties & taxonomies
Dental Providers
Practice location
2640 N Highway 162
Eden, UT 84310-9745
Phone: (801) 745-1100
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 805
Eden, UT 84310-0805
Registry dates
- Enumerated
- 2007-03-13
- Last updated
- 2014-11-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.