NPIMap

Organization Active NPI

Chisholm Family Dentistry Inc

  • General Practice Dentistry
  • Monroe, UT
National Provider Identifier
1255499083
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3241439921 Issued in UT
Legal business name
CHISHOLM FAMILY DENTISTRY INC
Practice address
30 S Main St
Monroe, UT 84754
Phone
(435) 527-3555
Fax
(435) 527-3618
NPI assigned
Dec 5, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Richard T Chilsholm, DDS
Title
Dentist Owner
Phone
(435) 527-3555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 3241439921 UT Primary

Addresses

Primary practice location

30 S Main St
Monroe, UT 84754

Mailing address

PO Box 69
30 S Main St
Monroe, UT 84754
Phone (435) 527-3555

Other identifiers 1

IdentifierTypeStateIssuer
528376111001MedicaidUT

Other names 1

  • Richard T Chilsholm DDS Former legal business name

National Provider Directory

National Provider Directory

Locations

30 S Main St
Monroe, UT 84754
Phone (435) 527-3555

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255499083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 69",
            "address_2": "30 S MAIN ST",
            "city": "MONROE",
            "state": "UT",
            "postal_code": "84754",
            "telephone_number": "435-527-3555",
            "fax_number": "435-527-3618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 S MAIN ST",
            "city": "MONROE",
            "state": "UT",
            "postal_code": "84754",
            "telephone_number": "435-527-3555",
            "fax_number": "435-527-3618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHISHOLM FAMILY DENTISTRY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHILSHOLM",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DENTIST OWNER",
        "authorized_official_telephone_number": "435-527-3555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "3241439921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528376111001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Richard T Chilsholm DDS",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Monroe, UT

Sources for this page

  • 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.