Active NPI
Bruce H Godderidge, DMD
- Dentist
- Smithfield, UT
National Provider Identifier
1053436816
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1431759922
- Practice address
- 291 South Main
Suite a
Smithfield, UT 84335 - Phone
- (435) 563-6213
- Fax
- (435) 563-8443
- NPI assigned
- Mar 20, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1431759922 | UT | Primary |
Addresses
Primary practice location
291 South Main
Suite a
Smithfield, UT 84335
Mailing address
291 So Main
Suite a
Smithfield, UT 84335
Phone (435) 563-6213
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1431759922 | UT | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rounds Dental, PLLC | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053436816",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "291 SO MAIN",
"address_2": "SUITE A",
"city": "SMITHFIELD",
"state": "UT",
"postal_code": "84335",
"telephone_number": "435-563-6213",
"fax_number": "435-563-8443"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "291 SOUTH MAIN",
"address_2": "SUITE A",
"city": "SMITHFIELD",
"state": "UT",
"postal_code": "84335",
"telephone_number": "435-563-6213",
"fax_number": "435-563-8443"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GODDERIDGE",
"first_name": "BRUCE",
"middle_name": "H",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "UT",
"license": "1431759922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Smithfield, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.