NPIMap

Organization Active NPI

SLC PDC PLLC

  • Dentist
  • Salt Lake City, UT
National Provider Identifier
1124438916
Registry record updated Jul 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
SLC PDC PLLC
Practice address
1963 S 1200 E
Ste 103
Salt Lake City, UT 84105-3523
Phone
(801) 466-1212
Fax
(801) 466-1919
NPI assigned
May 1, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2021

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

Authorized official

Name
Jacob Warner
Title
Credentialing Manager
Phone
(801) 691-1701

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

1963 S 1200 E
Ste 103
Salt Lake City, UT 84105-3523

Mailing address

PO Box 970687
Orem, UT 84097-0687
Phone (801) 691-1701

Other names 1

  • Platinum Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

1963 S 1200 E
Ste 103
Salt Lake City, UT 84105
Phone (801) 386-8696

Practitioners & affiliated clinicians

Practitioners 5

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": "1398902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625184000000",
    "number": "1124438916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 970687",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840970687",
            "telephone_number": "801-691-1701",
            "fax_number": "801-335-6551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1963 S 1200 E",
            "address_2": "STE 103",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841053523",
            "telephone_number": "801-466-1212",
            "fax_number": "801-466-1919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SLC PDC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-01",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A",
        "authorized_official_last_name": "WARNER",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "801-691-1701"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Platinum Dental Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Platinum Dental Care",
            "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 Jul 2, 2021; 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.