Active NPI
Daniel Rodriguez, DMD
- Dentist
- Salt Lake City, UT
National Provider Identifier
1265929640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6159362-9922
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210908001232 | UT | Order and Referring Only - Dentist | 0143626788 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6159362-9922 | UT | MD | General 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.