Active NPI
Samuel Blackham Bailey, DMD
- Pediatric Dentistry
- Taylorsville, UT
National Provider Identifier
1285990978
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 7693653-9922
- Practice address
- 2964 W 4700 S Ste 103
Taylorsville, UT 84129-2558 - Phone
- (801) 417-8080
- Fax
- (801) 417-8090
- NPI assigned
- Apr 6, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 7693653-9922 | UT | Primary |
Addresses
Primary practice location
2964 W 4700 S Ste 103
Taylorsville, UT 84129-2558
Mailing address
31 Lake Ridge Dr
Kaysville, UT 84037-9655
Phone (801) 259-6988
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7693653-9922 | UT | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brooklyn Dental Smiles | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Brooklyn, NY
- NPI 1598386922
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1333670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684195200000",
"number": "1285990978",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31 LAKE RIDGE DR",
"city": "KAYSVILLE",
"state": "UT",
"postal_code": "840379655",
"telephone_number": "801-259-6988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2964 W 4700 S STE 103",
"city": "TAYLORSVILLE",
"state": "UT",
"postal_code": "841292558",
"telephone_number": "801-417-8080",
"fax_number": "801-417-8090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAILEY",
"first_name": "SAMUEL",
"middle_name": "BLACKHAM",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-04-06",
"last_updated": "2023-05-16",
"certification_date": "2023-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "UT",
"license": "7693653-9922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Taylorsville, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.