Individual provider Active NPI

Justin Skinner, DMD

  • General Practice Dentistry
  • Salt Lake City, UT
National Provider Identifier
1083307359
Registry record updated Jun 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
13419926-9923 Issued in UT
Practice address
2304 E 1700 S
Salt Lake City, UT 84108-2721
Phone
(801) 845-6592
NPI assigned
Jun 1, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 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 13419926-9923 UT Primary

Addresses

Primary practice location

2304 E 1700 S
Salt Lake City, UT 84108-2721

Mailing address

2200 E 4500 S Ste 100
Holladay, UT 84117-4032
Phone (801) 845-6592

Other practice location 1

622 E 4500 S Ste 101
Murray, UT 84107-2922
Phone (801) 313-1800

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
13419926-9923UTMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Holladay Hills Family Dental P.C. General Practice CurrentSince Jun 4, 2023 Accepting new patients
Skinner Dental PastSince Oct 29, 2023 Accepting new patients

Locations

2200 E 4500 S
Ste 100
Holladay, UT 84117
Phone (801) 288-1888

622 E 4500 S
Ste 101
Salt Lake City, UT 84107
Phone (801) 313-1800

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1685577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685577600000",
    "number": "1083307359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 E 4500 S STE 100",
            "city": "HOLLADAY",
            "state": "UT",
            "postal_code": "841174032",
            "telephone_number": "801-845-6592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2304 E 1700 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841082721",
            "telephone_number": "801-845-6592"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "622 E 4500 S Ste 101",
            "address_purpose": "LOCATION",
            "city": "Murray",
            "state": "UT",
            "postal_code": "841072922",
            "country_code": "US",
            "telephone_number": "801-313-1800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SKINNER",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-01",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "13419926-9923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jun 1, 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.