NPIMap

Organization Active NPI

Modern Dental Professionals Utah, PC

Doing business as Monarch Dental - Riverdale

  • General Practice Dentistry
  • Ogden, UT
National Provider Identifier
1336404763
Registry record updated Apr 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MODERN DENTAL PROFESSIONALS UTAH, PC
Doing business as
Monarch Dental - Riverdale
Practice address
1140 W Riverdale Rd
Suite D
Ogden, UT 84405-3787
Phone
(801) 917-1502
Fax
(801) 436-3222
NPI assigned
Jul 11, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2024

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

Authorized official

Name
Liliana Martinez
Title
Credentialing Director
Phone
(949) 308-9792

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1140 W Riverdale Rd
Suite D
Ogden, UT 84405-3787

Mailing address

8415 Datapoint Dr Ste 1020
San Antonio, TX 78229-3277
Phone (210) 929-2814

Other names 1

  • Monarch Dental - Riverdale Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Modern Dental Professionals Utah PC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1140 W Riverdale Rd
Ste D
Riverdale, UT 84405
Phone (801) 917-1502

NPI Registry JSON

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

{
    "created_epoch": "1341964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712534400000",
    "number": "1336404763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8415 DATAPOINT DR STE 1020",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293277",
            "telephone_number": "210-929-2814",
            "fax_number": "210-615-3626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 W RIVERDALE RD",
            "address_2": "SUITE D",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844053787",
            "telephone_number": "801-917-1502",
            "fax_number": "801-436-3222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS UTAH, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-11",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "LILIANA",
        "authorized_official_title_or_position": "CREDENTIALING DIRECTOR",
        "authorized_official_telephone_number": "949-308-9792"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monarch Dental - Riverdale",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ogden, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2024; 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.