Mall Dental Group

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

140195-9922 Issued in UT

Legal business name

MALL DENTAL GROUP

Practice address

575 University Pkwy
I163
Orem, UT 84097-7400

Phone

(801) 426-6255

Fax

(801) 224-2966

NPI assigned

Jul 15, 2006

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

Dr. Kenneth Alvin Molen, D.D.S.

Title

Owner

Phone

(801) 426-6255

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Careers Unlimited Other name

Locations

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255357695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 UNIVERSITY PKWY",
            "address_2": "I163",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840977400",
            "telephone_number": "801-426-6255",
            "fax_number": "801-224-2966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 UNIVERSITY PKWY",
            "address_2": "I163",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840977400",
            "telephone_number": "801-426-6255",
            "fax_number": "801-224-2966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALL DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOLEN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "ALVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-426-6255",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "140195-9922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "516323007001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Careers Unlimited",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• General Practice Dentistry in Orem, UT
• Providers in Orem, UT by specialty
• General Practice Dentistry 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.