Stansbury Dental and Implant Center PDC PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

STANSBURY DENTAL AND IMPLANT CENTER PDC PLLC

Doing business as

Stansbury Dental and Implant Center

Practice address

263 Country Club Dr.
Suite 103
Stansbury Park, UT 84074-9600

Phone

(432) 882-2850

NPI assigned

Jul 15, 2013

Organization subpart

No

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

Authorized official

Name

Jacob Warner

Title

Credentialing Manager

Phone

(801) 691-1701

Specialties & licenses 4

Addresses

Other names 1

• Stansbury Dental and Implant Center Doing business as

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

{
    "created_epoch": "1373846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576713600000",
    "number": "1013358449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 970596",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840970309",
            "telephone_number": "801-305-3460",
            "fax_number": "801-335-6551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 COUNTRY CLUB DR.",
            "address_2": "SUITE 103",
            "city": "STANSBURY PARK",
            "state": "UT",
            "postal_code": "840749600",
            "telephone_number": "432-882-2850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANSBURY DENTAL AND IMPLANT CENTER PDC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-15",
        "last_updated": "2019-12-19",
        "certification_date": "2019-12-19",
        "status": "A",
        "authorized_official_last_name": "WARNER",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "801-691-1701"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "UT",
            "license": "341237",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stansbury Dental and Implant Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rylee Colleen Prokopis, DNP
• Isabeau Aurelia Robison
• Belle Rowan-Ferris, APRN, FNP-C
• Hilary S. Seibert, DO
• Linda Rose Shober, DPT
• Stansbury Park Dental Care
• Stansbury Park Orthodontics
• Stansbury Park Pediatric Dentistry
• Stansbury Pediatric Dentistry
• Stansbury Pediatric Dentistry and Orthodontics

• Dentist in Stansbury Park, UT
• Providers in Stansbury Park, UT by specialty
• Dentist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2019; 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.