Individual provider Active NPI

Michael Roy Bronson, D.D.S.

  • General Practice Dentistry
  • Clinton, UT
National Provider Identifier
1083684815
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5346717-9922 Issued in UT
Practice address
1448 N 2000 W
Suite #6
Clinton, UT 84015-8377
Phone
(801) 728-3924
Fax
(801) 728-9109
NPI assigned
Jan 24, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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 5346717-9922 UT Primary

Addresses

Primary practice location

1448 N 2000 W
Suite #6
Clinton, UT 84015-8377

Mailing address

1987 S 1840 W
Syracuse, UT 84075-8549
Phone (801) 710-8774

Other identifiers 1

IdentifierTypeStateIssuer
528564603001MedicaidUT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151228000338 UT Order and Referring Only - DentistPractitioner - Dentist 0648571216

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5346717-9922UTMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1083684815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1987 S 1840 W",
            "city": "SYRACUSE",
            "state": "UT",
            "postal_code": "840758549",
            "telephone_number": "801-710-8774",
            "fax_number": "801-728-9109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1448 N 2000 W",
            "address_2": "SUITE #6",
            "city": "CLINTON",
            "state": "UT",
            "postal_code": "840158377",
            "telephone_number": "801-728-3924",
            "fax_number": "801-728-9109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRONSON",
        "first_name": "MICHAEL",
        "middle_name": "ROY",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "5346717-9922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528564603001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, UT

Sources for this page

Verify at the official NPI Registry.