Individual provider Active NPI

Daniel Rodriguez, DMD

  • Dentist
  • Salt Lake City, UT
National Provider Identifier
1265929640
Registry record updated Sep 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6159362-9922 Issued in UT
Practice address
660 S 200 E Ste 250
Salt Lake City, UT 84111-3846
Phone
(801) 359-2256
NPI assigned
Apr 20, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health Dentistry 1223D0001X 6159362-9922 UT
General Practice Dentistry 1223G0001X 6159362-9922 UT
Student in an Organized Health Care Education/Training Program 390200000X
Dentist 122300000X 6159362-9922 UT Primary

Addresses

Primary practice location

660 S 200 E Ste 250
Salt Lake City, UT 84111-3846

Mailing address

10911 S 1055 W
South Jordan, UT 84095-8214
Phone (702) 884-1493

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210908001232 UT Order and Referring Only - DentistPractitioner - Dentist 0143626788

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6159362-9922UTMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1524182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599868800000",
    "number": "1265929640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10911 S 1055 W",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840958214",
            "telephone_number": "702-884-1493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 S 200 E STE 250",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841113846",
            "telephone_number": "801-359-2256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "DANIEL",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-20",
        "last_updated": "2020-09-12",
        "certification_date": "2020-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "UT",
            "license": "6159362-9922",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "6159362-9922",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "6159362-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.