Individual provider Active NPI

Joshua Bradley Haslem

  • General Practice Dentistry
  • Vernal, UT
National Provider Identifier
1366656357
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6563284-9922 Issued in UT
Practice address
1169 W Highway 40
Suite # C
Vernal, UT 84078-2911
Phone
(435) 781-2729
Fax
(435) 781-2719
NPI assigned
May 9, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 6563284-9922 UT Primary
General Practice Dentistry 1223G0001X 6563284-8903 UT

Addresses

Primary practice location

1169 W Highway 40
Suite # C
Vernal, UT 84078-2911

Mailing address

1169 W Highway 40
Suite # C
Vernal, UT 84078-2911
Phone (435) 781-2729

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
6563284-8903UTMDGeneral Practice Dentistry
6563284-9922UTMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366656357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1169 W HIGHWAY 40",
            "address_2": "SUITE # C",
            "city": "VERNAL",
            "state": "UT",
            "postal_code": "840782911",
            "telephone_number": "435-781-2729",
            "fax_number": "435-781-2719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1169 W HIGHWAY 40",
            "address_2": "SUITE # C",
            "city": "VERNAL",
            "state": "UT",
            "postal_code": "840782911",
            "telephone_number": "435-781-2729",
            "fax_number": "435-781-2719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASLEM",
        "first_name": "JOSHUA",
        "middle_name": "BRADLEY",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "6563284-9922",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "6563284-8903",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vernal, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.