Eli Garth Edmunds, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

5348114 Issued in UT

Practice address

12465 Fort St # 100
Draper, UT 84020-9363

Phone

(801) 576-1167

Fax

(801) 576-1169

NPI assigned

Apr 6, 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• 12465 S Fort St Draper Dental LLC

  dba Corner Canyon Family Dental

  • Dental Clinic/Center
  • Draper, UT
  • NPI 1790593051
  NPD (past)

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205958543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12465 FORT ST # 100",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840209363",
            "telephone_number": "801-576-1167",
            "fax_number": "801-576-1169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12465 FORT ST # 100",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840209363",
            "telephone_number": "801-576-1167",
            "fax_number": "801-576-1169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDMUNDS",
        "first_name": "ELI",
        "middle_name": "GARTH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "5348114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Draper, UT
• Providers in Draper, UT by specialty
• Dentist 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.