Tooele PDC PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

TOOELE PDC PLLC

Doing business as

Wasatch Orthodontics and Family Dentistry

Practice address

980 N Main St
Tooele, UT 84074-1616

Phone

(435) 248-0825

Fax

(435) 843-5490

NPI assigned

Dec 21, 2021

Last updated

Dec 21, 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

Jacob Warner

Title

Credentialing Manager

Phone

(801) 691-1701

Specialties & licenses 1

Addresses

Other names 1

• Wasatch Orthodontics and Family Dentistry Doing business as

Locations

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

{
    "created_epoch": "1640044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640044800000",
    "number": "1306506167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 970353",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840970353",
            "telephone_number": "435-248-0825",
            "fax_number": "435-843-5490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 N MAIN ST",
            "city": "TOOELE",
            "state": "UT",
            "postal_code": "840741616",
            "telephone_number": "435-248-0825",
            "fax_number": "435-843-5490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOOELE PDC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-21",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A",
        "authorized_official_last_name": "WARNER",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "801-691-1701"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wasatch Orthodontics and Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Tooele, UT
• Providers in Tooele, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 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.