Richard J Shamo, D.D.S., M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

8583943-9924 Issued in UT

Practice address

6287 S Redwood Rd Ste 103
Taylorsville, UT 84123

Phone

(801) 261-2444

NPI assigned

Jul 2, 2008

Sex

Male

Sole proprietor

No

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Feb 27, 2018 through Feb 27, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ut Oms Specialty Dental Services PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • West Jordan, UT
  • NPI 1194582031
  NPD (past)
• Ut Oms Specialty Dental Services PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Salt Lake City, UT
  • NPI 1407613342
  NPD (past)
• Ut Oms Specialty Dental Services PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Heber City, UT
  • NPI 1831956770
  NPD (past)

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

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536192000000",
    "number": "1356504005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4739 S WANDER LN",
            "city": "HOLLADAY",
            "state": "UT",
            "postal_code": "841175459",
            "telephone_number": "801-808-1692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6287 S REDWOOD RD STE 103",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "84123",
            "telephone_number": "801-261-2444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2620 Commercial Way Ste 110",
            "address_purpose": "LOCATION",
            "city": "Rock Springs",
            "state": "WY",
            "postal_code": "829014746",
            "country_code": "US",
            "telephone_number": "307-382-9115",
            "fax_number": "307-382-9192",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6268 S 900 E",
            "address_purpose": "LOCATION",
            "city": "Murray",
            "state": "UT",
            "postal_code": "841212497",
            "country_code": "US",
            "telephone_number": "801-566-5117",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "216 E Main St",
            "address_purpose": "LOCATION",
            "city": "Lehi",
            "state": "UT",
            "postal_code": "840432231",
            "country_code": "US",
            "telephone_number": "801-768-1155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAMO",
        "first_name": "RICHARD",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-02",
        "last_updated": "2018-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "WY",
            "license": "1381",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "UT",
            "license": "8583943-9924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Taylorsville, UT
• Providers in Taylorsville, UT by specialty
• Oral and Maxillofacial Surgery (Dentist) in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.