Shad B Mackert, D.D.S.

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

10220776-8903 Issued in UT

Practice address

12459 S 300 E Ste 202
Draper, UT 84020-1899

Phone

(385) 430-1200

NPI assigned

Jul 28, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1438041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695081600000",
    "number": "1144605403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12459 S 300 E STE 202",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840201899",
            "telephone_number": "854-301-2003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12459 S 300 E STE 202",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840201899",
            "telephone_number": "385-430-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKERT",
        "first_name": "SHAD",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-28",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "UT",
            "license": "10220776-8903",
            "primary": true
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "MI",
            "license": "2901021479",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901021479",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dillon Mabey
• Grace Macdowell, PSY.D.
• Grecia Maceda
• Macey'S Inc
• Jason Mackay, OD
• Jordan Mackey, FNP, APRN
• Richard Brian Mackey, MD
• Lauren Mackie
• Macmathan LC
• Austin Skylor Maddox

• Prosthodontics in Draper, UT
• Providers in Draper, UT by specialty
• Prosthodontics in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.