NPIMap

Organization Active NPI

University of Utah Adult Services

Doing business as School of Dentistry

  • Dentist
  • Salt Lake City, UT
National Provider Identifier
1083158257
Registry record updated Apr 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
UNIVERSITY OF UTAH ADULT SERVICES
Doing business as
School of Dentistry
Practice address
50 N Medical Dr Clinic # 7
Salt Lake City, UT 84132-1261
Phone
(801) 581-2016
NPI assigned
Dec 7, 2016
Last updated
Apr 8, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
UNIVERSITY OF UTAH ADULT SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 8, 2022

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

Authorized official

Name
Edward H Clark
Title
Department Chair
Phone
(801) 587-6636

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X Primary
General Practice Dentistry 1223G0001X
Sleep Medicine (Family Medicine) Physician 207QS1201X

Addresses

Primary practice location

50 N Medical Dr Clinic # 7
Salt Lake City, UT 84132-1261

Mailing address

PO Box 841450
Los Angeles, CA 90084-1450
Phone (801) 213-3900

Other names 1

  • School of Dentistry Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150209001683 UT Part B Supplier - Clinic/Group Practice 0941525273 Receives reassigned benefits from 3,021 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Sandy, UT; Salt Lake City, UT; Farmington, UT

National Provider Directory

National Provider Directory
Tax ID family
Univ of Ut Adult SVCS34 organizations share this tax ID, including this one
Part of
Univ of Ut Adult SVCS

Other organizations with this tax ID 33

Organizations that report the same tax identification number in the National Provider Directory.

View all 33

Practitioners & affiliated clinicians

Practitioners 43

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1481068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649376000000",
    "number": "1083158257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 841450",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900841450",
            "telephone_number": "801-213-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 N MEDICAL DR CLINIC # 7",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841321261",
            "telephone_number": "801-581-2016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF UTAH ADULT SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UNIVERSITY OF UTAH ADULT SERVICES",
        "enumeration_date": "2016-12-07",
        "last_updated": "2022-04-08",
        "certification_date": "2022-04-08",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "DEPARTMENT CHAIR",
        "authorized_official_telephone_number": "801-587-6636"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QS1201X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "School of Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "School of Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.