Bryan E Gottfredson, DDS
Individual provider Active NPI General Practice Dentistry · Magna, UT
NPI 1174501688 · NPPES record last updated Jul 12, 2010
Key facts
- NPI
- 1174501688
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 360010 (UT)
- Practice address
- 9010 W 2700 S
Magna, UT 84044-1002 - Phone
- (801) 250-7311
- Fax
- (801) 250-3801
- NPI assigned
- Jan 4, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 360010 | UT | MD | General Practice Dentistry |
Practice roles (3 of 4)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bristol Bay Area Health Corporation | Current | Accepting new patients | |
| Bryan E Gottfredson DDS | General Practice | Past | Accepting new patients |
| Magna PDC PLLC | General Practice | Past |
Accepting new patients |
Networks
- UT PPO D-SNP
Interoperability endpoints
- begottfredson@direct.bbahc.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 360010 | UT | Yes |
Addresses
Primary practice location
9010 W 2700 S
Magna, UT 84044-1002
Mailing address
9010 W 2700 S
Magna, UT 84044-1002
Phone (801) 250-7311
Other providers in Magna, UT
- Kristine Holly Frost
- Nathaniel Layne Gay
- Genesis Dental of Magna, LLC
- Janee Gillette
- Amanda Danielle Goodwin
- Alyssa Griffith
- Indira Gutierrez
- Ashley Hall
- Michel B Haynie
- Rebecca Marie Hennessy
All providers in Magna, UT · General Practice Dentistry in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.