Active NPI
Bradley Stephen Walker, DMD
- Pediatric Dentistry
- Holladay, UT
National Provider Identifier
1164688800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 7030084-9922
- Practice address
- 1434 E 4500 S Ste 102
Holladay, UT 84117-4252 - Phone
- (801) 273-5632
- NPI assigned
- Aug 1, 2008
- Last updated
- Sep 21, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 7030084-9922 | UT | |
| Pediatric Dentistry | 1223P0221X | 7030084-9922 | UT | Primary |
Addresses
Primary practice location
1434 E 4500 S Ste 102
Holladay, UT 84117-4252
Mailing address
1434 E 4500 S Ste 102
Holladay, UT 84117-4252
Phone (801) 273-5632
Other practice location 1
1834 S State St
Orem, UT 84097-8109
Phone (801) 224-0222
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7030084-9922 | UT | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Young Family Dental | Single Specialty | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537488000000",
"number": "1164688800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1434 E 4500 S STE 102",
"city": "HOLLADAY",
"state": "UT",
"postal_code": "841174252",
"telephone_number": "801-273-5632"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1434 E 4500 S STE 102",
"city": "HOLLADAY",
"state": "UT",
"postal_code": "841174252",
"telephone_number": "801-273-5632"
}
],
"practiceLocations": [
{
"address_1": "1834 S State St",
"address_purpose": "LOCATION",
"city": "Orem",
"state": "UT",
"postal_code": "840978109",
"country_code": "US",
"telephone_number": "801-224-0222",
"fax_number": "801-226-7560",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALKER",
"first_name": "BRADLEY",
"middle_name": "STEPHEN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-08-01",
"last_updated": "2018-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "UT",
"license": "7030084-9922",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "UT",
"license": "7030084-9922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holladay, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.