NPIMap

Organization Active NPI

Logan PDC PLLC

Doing business as Platinum Dental Care

  • General Practice Dentistry
  • Logan, UT
National Provider Identifier
1457801078
Registry record updated Jul 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
289803-9923 Issued in UT
Legal business name
LOGAN PDC PLLC
Doing business as
Platinum Dental Care
Practice address
167 E 200 N
Ste 3
Logan, UT 84321-4049
Phone
(435) 752-3689
Fax
(435) 752-8217
NPI assigned
Oct 6, 2016
Last updated
Jul 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2021

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

Authorized official

Name
Jacob Warner
Title
Credentialing Manager
Phone
(801) 691-1701

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 289803-9923 UT Primary

Addresses

Primary practice location

167 E 200 N
Ste 3
Logan, UT 84321-4049

Mailing address

PO Box 970924
Orem, UT 84097-0924
Phone (801) 691-1701

Other names 1

  • Platinum Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

167 E 200 N
Ste 3
Logan, UT 84321
Phone (435) 363-3584

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1475712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625184000000",
    "number": "1457801078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 970924",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840970924",
            "telephone_number": "801-691-1701",
            "fax_number": "801-335-6551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 E 200 N",
            "address_2": "STE 3",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843214049",
            "telephone_number": "435-752-3689",
            "fax_number": "435-752-8217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGAN PDC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-06",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A",
        "authorized_official_last_name": "WARNER",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "801-691-1701"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "289803-9923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Platinum Dental Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Platinum Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Logan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2021; 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.