Individual provider Active NPI

Blair I Losee

  • General Practice Dentistry
  • Lehi, UT
National Provider Identifier
1073654299
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
139721-9922 Issued in UT
Practice address
3098 North Executive Pkwy
Suite #250
Lehi, UT 84043
Phone
(801) 766-5300
Fax
(801) 766-5445
NPI assigned
Feb 9, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 139721-9922 UT Primary

Addresses

Primary practice location

3098 North Executive Pkwy
Suite #250
Lehi, UT 84043

Mailing address

1405 Magic Wand St
Draper, UT 84020-7537
Phone (801) 545-0257

Other identifiers 2

IdentifierTypeStateIssuer
87-0370312OtherUTTAX ID #
139721-9922OtherUTSTATE ID #

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

LicenseStateTypeSpecialty
139721-9922UTMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1073654299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 MAGIC WAND ST",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840207537",
            "telephone_number": "801-545-0257",
            "fax_number": "801-766-5445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3098 NORTH EXECUTIVE PKWY",
            "address_2": "SUITE #250",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "84043",
            "telephone_number": "801-766-5300",
            "fax_number": "801-766-5445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOSEE",
        "first_name": "BLAIR",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-09",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "139721-9922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID #",
            "identifier": "87-0370312",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE ID #",
            "identifier": "139721-9922",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lehi, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.