Herriman Pediatric Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

8858650 Issued in UT

Legal business name

HERRIMAN PEDIATRIC DENTISTRY

Practice address

11996 S Anthem Park Blvd # 101
Herriman, UT 84096-5643

Phone

(801) 877-5800

Fax

(801) 907-7266

NPI assigned

Jul 29, 2016

Organization subpart

No

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

Authorized official

Name

Charles Odion, DDS

Title

Owner

Phone

(801) 877-5800

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1469750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469750400000",
    "number": "1376096966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11996 S ANTHEM PARK BLVD # 101",
            "city": "HERRIMAN",
            "state": "UT",
            "postal_code": "840965643",
            "telephone_number": "801-877-5800",
            "fax_number": "801-907-7266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11996 S ANTHEM PARK BLVD # 101",
            "city": "HERRIMAN",
            "state": "UT",
            "postal_code": "840965643",
            "telephone_number": "801-877-5800",
            "fax_number": "801-907-7266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERRIMAN PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-29",
        "last_updated": "2016-07-29",
        "status": "A",
        "authorized_official_last_name": "ODION",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-877-5800",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "UT",
            "license": "8858650",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "556752017001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Heinhold, MSW
• Julie Ann Herdt
• Herriman Counseling Services, LLC
• Herriman Enterprises LLC
• Herriman Family Medicine
• Herriman Physical Therapy PC
• Danica Ryan Herron, PHARMD
• Trevor Hillock
• Tyson Kyle Hinton, RBT
• Tommy Hirschi

• Pediatric Dentistry in Herriman, UT
• Providers in Herriman, UT by specialty
• Pediatric Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2016; 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.