NPIMap

Organization Active NPI

Bonneville Preventive Dentistry PLLC

  • Dental Clinic/Center
  • Ogden, UT
National Provider Identifier
1255776431
Registry record updated May 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
8289908 Issued in UT
Legal business name
BONNEVILLE PREVENTIVE DENTISTRY PLLC
Practice address
3860 Jackson Ave
Suite 6
Ogden, UT 84403-1956
Phone
(801) 627-0420
NPI assigned
May 1, 2013
Last updated
May 1, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2013

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

Authorized official

Name
Matthew Wolpert, DMDNPI 1093087629
Title
Director
Phone
(801) 627-0420

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 8289908 UT Primary

Addresses

Primary practice location

3860 Jackson Ave
Suite 6
Ogden, UT 84403-1956

Mailing address

3860 Jackson Ave
Suite 6
Ogden, UT 84403-1956
Phone (801) 627-0420

National Provider Directory

National Provider Directory

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": "1367366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367366400000",
    "number": "1255776431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3860 JACKSON AVE",
            "address_2": "SUITE 6",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844031956",
            "telephone_number": "801-627-0420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3860 JACKSON AVE",
            "address_2": "SUITE 6",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844031956",
            "telephone_number": "801-627-0420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONNEVILLE PREVENTIVE DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-01",
        "last_updated": "2013-05-01",
        "status": "A",
        "authorized_official_last_name": "WOLPERT",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "801-627-0420",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "UT",
            "license": "8289908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ogden, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 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.