Individual provider Active NPI

Michael Lee Tribe, D.D.S.

  • General Practice Dentistry
  • Ogden, UT
National Provider Identifier
1104973395
Registry record updated Nov 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
143106-9922 Issued in UT
Practice address
1770 E 5625 S Ste 1
Ogden, UT 84403-5067
Phone
(801) 475-4700
Fax
(801) 475-1888
NPI assigned
Jan 3, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 8, 2011

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 143106-9922 UT Primary

Addresses

Primary practice location

1770 E 5625 S Ste 1
Ogden, UT 84403-5067

Mailing address

1770 E 5625 S Ste 1
Ogden, UT 84403-5067
Phone (801) 475-4700

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
I20160502001434 UT Order and Referring Only - DentistPractitioner - Dentist 5597064295

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320710400000",
    "number": "1104973395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1770 E 5625 S STE 1",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844035067",
            "telephone_number": "801-475-4700",
            "fax_number": "801-475-1888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1770 E 5625 S STE 1",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844035067",
            "telephone_number": "801-475-4700",
            "fax_number": "801-475-1888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRIBE",
        "first_name": "MICHAEL",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-03",
        "last_updated": "2011-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "143106-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ogden, UT

Sources for this page

Verify at the official NPI Registry.