NPIMap

Organization Active NPI

Kids Town Pediatric Dentistry

  • Pediatric Dentistry
  • Layton, UT
National Provider Identifier
1356607493
Registry record updated Jul 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
6362621-9922 Issued in UT
Legal business name
KIDS TOWN PEDIATRIC DENTISTRY
Practice address
2940 N. Church St.
#301
Layton, UT 84040
Phone
(801) 799-2900
Fax
(801) 217-3950
NPI assigned
Apr 3, 2012
Last updated
Jul 17, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2013

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

Authorized official

Name
Brett Packham, DDS
Title
Owner/Dentist
Phone
(801) 799-2900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 6362621-9922 UT Primary

Addresses

Primary practice location

2940 N. Church St.
#301
Layton, UT 84040

Mailing address

2940 N. Church St.
#301
Layton, UT 84040
Phone (801) 799-2900

National Provider Directory

National Provider Directory
Tax ID family
Kids Town Pediatric Dentistry3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

2940 N Church St
Ste 301
Layton, UT 84040
Phone (801) 799-2900

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1333411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374019200000",
    "number": "1356607493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2940 N. CHURCH ST.",
            "address_2": "#301",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "84040",
            "telephone_number": "801-799-2900",
            "fax_number": "801-217-3950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2940 N. CHURCH ST.",
            "address_2": "#301",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "84040",
            "telephone_number": "801-799-2900",
            "fax_number": "801-217-3950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS TOWN PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-03",
        "last_updated": "2013-07-17",
        "status": "A",
        "authorized_official_last_name": "PACKHAM",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "801-799-2900",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "UT",
            "license": "6362621-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Layton, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2013; 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.