NPIMap

Organization Active NPI

Ut Oms Specialty Dental Services PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Provo, UT
National Provider Identifier
1376206755
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
UT OMS SPECIALTY DENTAL SERVICES PLLC
Practice address
777 N 500 W Ste 102
Provo, UT 84601-1598
Phone
(801) 750-9672
NPI assigned
Oct 21, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

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

Authorized official

Name
Charlotte V Dasch
Title
Director of Provider Relations
Phone
(615) 678-0759

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

777 N 500 W Ste 102
Provo, UT 84601-1598

Mailing address

401 Church St Ste 1400
Nashville, TN 37219-2214
Phone (615) 678-0759

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL office Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220323001638 UT Part B Supplier - Clinic/Group Practice 1850786112 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: American Fork, UT; Price, UT; Provo, UT

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Ut Oms Specialty Dental Services PLLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

1022 E 220 S
American Fork, UT 84003
Phone (801) 756-0766

391 N 400 E
Price, UT 84501
Phone (435) 637-2222

Ownership & related parties

Subparts reporting this organization as parent 5

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1634774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634774400000",
    "number": "1376206755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 CHURCH ST STE 1400",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372192214",
            "telephone_number": "615-678-0759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 N 500 W STE 102",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846011598",
            "telephone_number": "801-750-9672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UT OMS SPECIALTY DENTAL SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-21",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A",
        "authorized_official_last_name": "DASCH",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "DIRECTOR OF PROVIDER RELATIONS",
        "authorized_official_telephone_number": "615-678-0759"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "office",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "777 N 500 W Ste 102",
            "city": "Provo",
            "state": "UT",
            "country_code": "US",
            "postal_code": "846011598",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.