Main Street Dental of Salt Lake City

Primary specialty

Point of ServiceTaxonomy code 305S00000X

Legal business name

MAIN STREET DENTAL OF SALT LAKE CITY

Practice address

3195 S Main St Ste 201
Salt Lake City, UT 84115-3749

Phone

(801) 792-6033

NPI assigned

Aug 27, 2015

Last updated

Aug 27, 2015By 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

Jennifer D WilsonNPI 1902784317

Title

Manager/Owner

Phone

(801) 792-6033

Specialties & licenses 1

Addresses

Other names 1

• Main Street Dental of Salt Lake City Former legal business name

Locations

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.

• Jennifer Daye Wilson, FNP

  • Registered Nurse
  • Las Vegas, NV
  • NPI 1902784317
  Authorized official Same address or phone

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

{
    "created_epoch": "1440633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440633600000",
    "number": "1245607068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7922 S GOLDENPOINTE WAY",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840887672",
            "telephone_number": "801-792-6033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3195 S MAIN ST STE 201",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841153749",
            "telephone_number": "801-792-6033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET DENTAL OF SALT LAKE CITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-27",
        "last_updated": "2015-08-27",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MANAGER/OWNER",
        "authorized_official_telephone_number": "801-792-6033"
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Dental of Salt Lake City",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Thomas M Mahoney, AUDIOLOGIST
• Anh Thao Mai, PHARMD
• Robbert Maib
• Katherine Ann Mailey, M.D.
• Elvina Tiare Mailo
• Robin Gay Mainwaring, MD
• Jason Lee Mair
• Lindsey Marie Mair, SLP-CCC
• Margaret Mair, M.D.
• Patrick Maitre, PA-C

• Point of Service in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Point of Service in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 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.