NPIMap

Organization Active NPI

Dental Center of St. George LLC

  • Health Maintenance Organization
  • St George, UT
National Provider Identifier
1215320775
Registry record updated Mar 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
License
0035640 Issued in UT
Legal business name
DENTAL CENTER OF ST. GEORGE LLC
Practice address
321 N Mall Dr
#P101
St George, UT 84790-7302
Phone
(435) 673-4809
Fax
(435) 628-5939
NPI assigned
Mar 9, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2015

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

Authorized official

Name
Jackie ImlayNPI 1851783203
Title
Owner
Phone
(435) 673-4809

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X 0035640 UT Primary

Addresses

Primary practice location

321 N Mall Dr
#P101
St George, UT 84790-7302

Mailing address

321 N Mall Dr
#P101
St George, UT 84790-7302
Phone (435) 673-4809

National Provider Directory

National Provider Directory

Locations

321 N Mall Dr
Ste P101
St George, UT 84790
Phone (435) 673-4809

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1425859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425859200000",
    "number": "1215320775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 N MALL DR",
            "address_2": "#P101",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847907302",
            "telephone_number": "435-673-4809",
            "fax_number": "435-628-5939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 N MALL DR",
            "address_2": "#P101",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847907302",
            "telephone_number": "435-673-4809",
            "fax_number": "435-628-5939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL CENTER OF ST. GEORGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-09",
        "last_updated": "2015-03-09",
        "status": "A",
        "authorized_official_last_name": "IMLAY",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "435-673-4809"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "UT",
            "license": "0035640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St George, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2015; 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.