NPIMap

Organization Active NPI

Central Fossa LLC

  • Dentist
  • Sandy, UT
National Provider Identifier
1225470909
Registry record updated Jul 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8628346 Issued in UT
Legal business name
CENTRAL FOSSA LLC
Practice address
7369 Creek Road
Sandy, UT 84121
Phone
(801) 566-5577
Fax
(801) 566-4848
NPI assigned
Jul 23, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2013

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

Authorized official

Name
Amy E. Florance Dethorn, DMD
Title
Owner
Phone
(801) 566-5577

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 8628346 UT Primary

Addresses

Primary practice location

7369 Creek Road
Sandy, UT 84121

Mailing address

7369 Creek Road
Sandy, UT 84121
Phone (801) 566-5577

Other names 1

  • Creek Road Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

7369 S Creek Rd
Sandy, UT 84093
Phone (801) 566-5577

Practitioners & affiliated clinicians

Practitioners 3

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": "1374537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374537600000",
    "number": "1225470909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7369 CREEK ROAD",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "84121",
            "telephone_number": "801-566-5577",
            "fax_number": "801-566-4848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7369 CREEK ROAD",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "84121",
            "telephone_number": "801-566-5577",
            "fax_number": "801-566-4848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL FOSSA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-23",
        "last_updated": "2013-07-23",
        "status": "A",
        "authorized_official_last_name": "FLORANCE DETHORN",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-566-5577",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "UT",
            "license": "8628346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Creek Road Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sandy, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; 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.