Copper Creek Dental, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

373483-9922 Issued in UT

Legal business name

COPPER CREEK DENTAL, PC

Practice address

3078 W 7800 S
Ste 7-B
West Jordan, UT 84088-3707

Phone

(801) 280-1911

Fax

(801) 255-2394

NPI assigned

Jul 13, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Robert J Staley, D.M.D

Title

President/Owner

Phone

(801) 280-1911

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316962079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3078 W 7800 S",
            "address_2": "STE 7-B",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840883707",
            "telephone_number": "801-280-1911",
            "fax_number": "801-255-2394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3078 W 7800 S",
            "address_2": "STE 7-B",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840883707",
            "telephone_number": "801-280-1911",
            "fax_number": "801-255-2394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COPPER CREEK DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STALEY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "801-280-1911",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "373483-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in West Jordan, UT
• Providers in West Jordan, 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 Aug 22, 2020; 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.