NPIMap

Organization Active NPI

Simply Dental of South Jordan, LLC

  • General Practice Dentistry
  • South Jordan, UT
National Provider Identifier
1093138448
Registry record updated Jan 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
139125 Issued in UT
Legal business name
SIMPLY DENTAL OF SOUTH JORDAN, LLC
Practice address
1268 W South Jordan Pkwy
Suite 302
South Jordan, UT 84095-4652
Phone
(801) 253-3900
Fax
(801) 253-3342
NPI assigned
Jan 21, 2014
Organization subpart
Yes
Parent organization
SIMPLY DENTAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 21, 2014

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

Authorized official

Name
Mr. Marcus H Webb
Title
Owner/Business Director
Phone
(801) 915-5947

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 139125 UT Primary

Addresses

Primary practice location

1268 W South Jordan Pkwy
Suite 302
South Jordan, UT 84095-4652

Mailing address

1268 W South Jordan Pkwy
Suite 302
South Jordan, UT 84095-4652
Phone (801) 253-3900

Other names 1

  • South Jordan Dental Doing business as

National Provider Directory

National Provider Directory

Locations

1268 W South Jordan Pkwy
Ste 302
South Jordan, UT 84095
Phone (801) 253-3900

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1390262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390262400000",
    "number": "1093138448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1268 W SOUTH JORDAN PKWY",
            "address_2": "SUITE 302",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840954652",
            "telephone_number": "801-253-3900",
            "fax_number": "801-253-3342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1268 W SOUTH JORDAN PKWY",
            "address_2": "SUITE 302",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840954652",
            "telephone_number": "801-253-3900",
            "fax_number": "801-253-3342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMPLY DENTAL OF SOUTH JORDAN, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SIMPLY DENTAL GROUP, LLC",
        "enumeration_date": "2014-01-21",
        "last_updated": "2014-01-21",
        "status": "A",
        "authorized_official_last_name": "WEBB",
        "authorized_official_first_name": "MARCUS",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER/BUSINESS DIRECTOR",
        "authorized_official_telephone_number": "801-915-5947",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "139125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Jordan Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Jordan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2014; 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.