Clint G. Iverson, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4758652 Issued in UT

Practice address

1770 Combe Rd
Suite 2
Ogden, UT 84403-5013

Phone

(801) 475-1999

Fax

(801) 475-1888

NPI assigned

Jan 29, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Moyes Iverson Dental LLC

  • Dentist
  • Ogden, UT
  • NPI 1821155581
  NPD (past)

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164568952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1770 COMBE RD",
            "address_2": "SUITE 2",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844035013",
            "telephone_number": "801-475-1999",
            "fax_number": "801-475-1888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1770 COMBE RD",
            "address_2": "SUITE 2",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844035013",
            "telephone_number": "801-475-1999",
            "fax_number": "801-475-1888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVERSON",
        "first_name": "CLINT",
        "middle_name": "G.",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "4758652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ismile at Ogden Dental PLLC
• Marcella Israel Rocha, MD
• Melissa Arlene Ita'Aehau, PT
• Ashlee Ito
• Michael Travis Ivan, DO
• Mary Jean Iverson, CPCI
• Richard Blaine Iverson, D.O.
• Jessica Ivy
• Kyle Jackman, D.O
• Angela Maria Jackson, LPC

• General Practice Dentistry in Ogden, UT
• Providers in Ogden, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.