NPIMap

Organization Active NPI

Professional Dental LLC

  • General Practice Dentistry
  • Payson, UT
National Provider Identifier
1457476376
Registry record updated Mar 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
56928280160 Issued in UT
Legal business name
PROFESSIONAL DENTAL LLC
Practice address
78 E 100 S
Payson, UT 84651-2262
Phone
(801) 465-0550
Fax
(801) 465-9475
NPI assigned
Mar 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2017

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) 785-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 56928280160 UT Primary

Addresses

Primary practice location

78 E 100 S
Payson, UT 84651-2262

Mailing address

PO Box 1715
Orem, UT 84059-1715
Phone (801) 785-8000

National Provider Directory

National Provider Directory

Locations

312 N Market Place Dr
Centerville, UT 84014
Phone (801) 292-9111

1352 E Eagle Mountain Blvd
Unit E
Eagle Mountain, UT 84005

957 S Highway 89
Ste 120
Logan, UT 84321

78 E 100 S
Payson, UT 84651
Phone (801) 465-0550

Ownership & related parties

Subparts reporting this organization as parent 1

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

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489104000000",
    "number": "1457476376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1715",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840591715",
            "telephone_number": "801-785-8000",
            "fax_number": "801-465-9475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78 E 100 S",
            "city": "PAYSON",
            "state": "UT",
            "postal_code": "846512262",
            "telephone_number": "801-465-0550",
            "fax_number": "801-465-9475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2017-03-10",
        "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": "801-785-8000"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "56928280160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Payson, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2017; 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.