NPIMap

Organization Active NPI

Modern Dental Professionals Ut, PC

  • Dentist
  • South Ogden, UT
National Provider Identifier
1265889166
Registry record updated Apr 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
141895-9921 Issued in UT
Legal business name
MODERN DENTAL PROFESSIONALS UT, PC
Practice address
5974 S. Fashion Pointe Drive
Suite 210
South Ogden, UT 84403
Phone
(801) 475-6121
Fax
(801) 471-0919
NPI assigned
May 20, 2016
Organization subpart
Yes
Parent organization
MODERN DENTAL PROFESSIONALS UT, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 8, 2024

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

Authorized official

Name
Liliana Martinez
Title
Credentialing Director
Phone
(493) 089-7929

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 141895-9921 UT Primary

Addresses

Primary practice location

5974 S. Fashion Pointe Drive
Suite 210
South Ogden, UT 84403

Mailing address

8415 Datapoint Drive
Suite 1020
San Antonio, TX 78229
Phone (714) 578-6358

Other names 1

  • Monarch Dental - South Ogden Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Modern Dental Professionals Utah PC10 organizations share this tax ID, including this one
Part of
Modern Dental Professionals Utah PC

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5974 Fashion Point Dr
Ste 210
South Ogden, UT 84403
Phone (801) 475-6121

Practitioners & affiliated clinicians

Practitioners 2

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": "1463702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712534400000",
    "number": "1265889166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8415 DATAPOINT DRIVE",
            "address_2": "SUITE 1020",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78229",
            "telephone_number": "714-578-6358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5974 S. FASHION POINTE DRIVE",
            "address_2": "SUITE 210",
            "city": "SOUTH OGDEN",
            "state": "UT",
            "postal_code": "84403",
            "telephone_number": "801-475-6121",
            "fax_number": "801-471-0919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS UT, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MODERN DENTAL PROFESSIONALS UT, PC",
        "enumeration_date": "2016-05-20",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "LILIANA",
        "authorized_official_title_or_position": "CREDENTIALING DIRECTOR",
        "authorized_official_telephone_number": "493-089-7929"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "UT",
            "license": "141895-9921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monarch Dental - South Ogden",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Ogden, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2024; 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.