Southridge Pediatric Dentistry

Primary specialty

DentistTaxonomy code 122300000X

License

343291 Issued in UT

Legal business name

SOUTHRIDGE PEDIATRIC DENTISTRY

Practice address

2651 W. 10400 S. #103
South Jordan, UT 84095

Phone

(801) 445-1515

Fax

(801) 446-5290

NPI assigned

May 25, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David C Roth, DDSNPI 1285685594

Title

Owner

Phone

(801) 446-1515

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David Christian Roth, DDS

  • Pediatric Dentistry
  • South Jordan, UT
  • NPI 1285685594
  Authorized official Same address or phone

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225249683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2651 W. 10400 S. #103",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "84095",
            "telephone_number": "801-445-1515",
            "fax_number": "801-446-5290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2651 W. 10400 S. #103",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "84095",
            "telephone_number": "801-445-1515",
            "fax_number": "801-446-5290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHRIDGE PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROTH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-446-1515",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "UT",
            "license": "343291",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "UT",
            "license": "5667938",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Jordan PDC PLLC (Cornerstone Dental)
• South Mountain Dialysis, LLC
• South Point Counseling Services, LLC
• South Valley Orthomed, PLLC
• South Valley Speech and Language, LLC
• Southwest Chiropractic, Inc.
• Southwest Oral and Facial Surgery Inc
• Michaelle Lei Spears, APRN
• Brandon Christopher Spellen, RN
• Terra Spencer, CSW

• Dentist in South Jordan, UT
• Providers in South Jordan, UT by specialty
• Dentist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.