Taylor Paul Ericksen, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

10299296-9922 Issued in UT

Practice address

5974 Fashion Point Dr
South Ogden, UT 84403

Phone

(801) 475-6121

Fax

(801) 475-4797

NPI assigned

Jul 27, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1437955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560124800000",
    "number": "1326423872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5974 FASHION POINT DR",
            "city": "SOUTH OGDEN",
            "state": "UT",
            "postal_code": "844034699",
            "telephone_number": "801-475-6121",
            "fax_number": "801-475-4797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5974 FASHION POINT DR",
            "city": "SOUTH OGDEN",
            "state": "UT",
            "postal_code": "84403",
            "telephone_number": "801-475-6121",
            "fax_number": "801-475-4797"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5974 Fashion Point Dr",
            "address_purpose": "LOCATION",
            "city": "South Ogden",
            "state": "UT",
            "postal_code": "84403",
            "country_code": "US",
            "telephone_number": "801-475-6121",
            "fax_number": "801-475-4797",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ERICKSEN",
        "first_name": "TAYLOR",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-27",
        "last_updated": "2019-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019030302",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019030302",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "10299296-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in South Ogden, UT
• Providers in South Ogden, UT by specialty
• Dentist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2019; 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.