Wisdom Teeth of Southern Utah

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

WISDOM TEETH OF SOUTHERN UTAH

Practice address

446 S Mall Dr Ste 100
St George, UT 84790-4944

Phone

(435) 673-3490

Fax

(435) 627-9954

NPI assigned

Jan 23, 2019

Last updated

Jan 23, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

ST. GEORGE KIDS DENTAL AT SNOW CANYONAs reported in NPPES

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

Authorized official

Name

Dayne Jensen, DMD MD

Title

Owner

Phone

(435) 673-3490

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wisdom Teeth of Southern Utah Other name

Part of

St George Kids Dental at Snow Canyon

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• St. George Kids Dental at Snow Canyon

  • Pediatric Dentistry
  • Santa Clara, UT
  • NPI 1639667801
  NPPES parent name

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

{
    "created_epoch": "1548201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548201600000",
    "number": "1467916528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "446 S MALL DR STE 100",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847904944",
            "telephone_number": "435-673-3490",
            "fax_number": "435-627-9954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "446 S MALL DR STE 100",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847904944",
            "telephone_number": "435-673-3490",
            "fax_number": "435-627-9954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISDOM TEETH OF SOUTHERN UTAH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. GEORGE KIDS DENTAL AT SNOW CANYON",
        "enumeration_date": "2019-01-23",
        "last_updated": "2019-01-23",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "DAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "435-673-3490",
        "authorized_official_credential": "DMD MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1881926509",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wisdom Teeth of Southern Utah",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Philip Wintch, LCSW
• Richard W Wintch, M.D.
• Braelynn P Winter
• Jason Winward, MD
• Tracy W Winward, M.D.
• Lincoln Wise
• Cindi Witt, BCBA
• Emma Wittemund
• Lyla Rose Wittwer
• Nicholas Paul Wittwer, P.A.

• Oral and Maxillofacial Surgery (Dentist) in St George, UT
• Providers in St George, UT by specialty
• Oral and Maxillofacial Surgery (Dentist) in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2019; 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.