Kelly A Faddis, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

144920-9922 Issued in UT

Practice address

11760 S 700 E
#110
Draper, UT 84020-6604

Phone

(801) 571-6688

Fax

(801) 571-7787

NPI assigned

Jun 11, 2006

Last updated

May 31, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Networks

• UT PPO D-SNP

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chase Judd, DDS, PLLC

  • Dentist
  • Draper, UT
  • NPI 1316419294
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306800000000",
    "number": "1003858432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11760 S 700 E",
            "address_2": "#110",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840206604",
            "telephone_number": "801-571-6688",
            "fax_number": "801-571-7787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11760 S 700 E",
            "address_2": "#110",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840206604",
            "telephone_number": "801-571-6688",
            "fax_number": "801-571-7787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADDIS",
        "first_name": "KELLY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-11",
        "last_updated": "2011-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "144920-9922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL ID #",
            "identifier": "87-0581297",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Alyssa Isabel Fallon
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• General Practice Dentistry in Draper, UT
• Providers in Draper, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.