Basin Family Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

BASIN FAMILY DENTAL LLC

Practice address

209 W 200 N # 71
Roosevelt, UT 84066-2835

Phone

(435) 722-2111

NPI assigned

Apr 26, 2021

Last updated

Apr 26, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tiffany Bray

Title

Manager

Phone

(435) 637-2100

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1619395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619395200000",
    "number": "1295317667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 W 200 N # 71",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840662835",
            "telephone_number": "435-722-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 W 200 N # 71",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840662835",
            "telephone_number": "435-722-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BASIN FAMILY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-26",
        "last_updated": "2021-04-26",
        "certification_date": "2021-04-26",
        "status": "A",
        "authorized_official_last_name": "BRAY",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "435-637-2100"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600290118011",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Auralcare Hearing Centers of America, LLC (My Hearing Centers)
• Ryan James Avery, MOTR/L
• Jordan R Baadsgaard, P.T.
• Jannell Barker
• Bonnie J Barnes, RN
• Basin Family Dentistry, PC
• Basin Family Pharmacy
• Basin Therapy LLC
• Vail Shanae Batty, RN
• Kerry Robert Baum Jr., MD

• Dental Clinic/Center in Roosevelt, UT
• Providers in Roosevelt, UT by specialty
• Dental Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2021; 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.