Professional Dental West Valley LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PROFESSIONAL DENTAL WEST VALLEY LLC

Practice address

3601 S 2700 W
West Valley, UT 84119-3746

Phone

(801) 785-8000

Fax

(801) 785-4030

NPI assigned

Oct 20, 2023

Organization subpart

No

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

Authorized official

Name

Robert D Hack

Title

Owner

Phone

(801) 636-0110

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1697760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707264000000",
    "number": "1457133779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1806",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840591806",
            "telephone_number": "801-785-8000",
            "fax_number": "801-785-4030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 S 2700 W",
            "city": "WEST VALLEY",
            "state": "UT",
            "postal_code": "841193746",
            "telephone_number": "801-785-8000",
            "fax_number": "801-785-4030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL WEST VALLEY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-20",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A",
        "authorized_official_last_name": "HACK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-636-0110"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in West Valley, UT
• Providers in West Valley, UT by specialty
• Dental Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2024; 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.