NPIMap

Organization Active NPI

Legacy Family Dental of Bountiful LLC

  • Health Maintenance Organization
  • Bountiful, UT
National Provider Identifier
1275859589
Registry record updated Apr 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
License
75313980160 Issued in UT
Legal business name
LEGACY FAMILY DENTAL OF BOUNTIFUL LLC
Practice address
55 E 2200 S
Bountiful, UT 84010-5619
Phone
(801) 295-5115
Fax
(801) 397-5559
NPI assigned
Apr 12, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2010

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

Authorized official

Name
Mr. Kase Peery
Title
Owner/Managing Member
Phone
(801) 870-0838

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X 75313980160 UT Primary

Addresses

Primary practice location

55 E 2200 S
Bountiful, UT 84010-5619

Mailing address

55 E 2200 S
Bountiful, UT 84010-5619
Phone (801) 295-5115

National Provider Directory

National Provider Directory

Locations

55 E 2200 S
Bountiful, UT 84010
Phone (801) 295-5115

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": "1271030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271030400000",
    "number": "1275859589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 E 2200 S",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840105619",
            "telephone_number": "801-295-5115",
            "fax_number": "801-397-5559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 E 2200 S",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840105619",
            "telephone_number": "801-295-5115",
            "fax_number": "801-397-5559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY FAMILY DENTAL OF BOUNTIFUL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-12",
        "last_updated": "2010-04-12",
        "status": "A",
        "authorized_official_last_name": "PEERY",
        "authorized_official_first_name": "KASE",
        "authorized_official_title_or_position": "OWNER/MANAGING MEMBER",
        "authorized_official_telephone_number": "801-870-0838",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "UT",
            "license": "75313980160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bountiful, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2010; 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.