Bountiful Ridge Dental, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8008797 Issued in UT

Legal business name

BOUNTIFUL RIDGE DENTAL, LLC

Practice address

415 Medical Dr Ste A200
Bountiful, UT 84010-4970

Phone

(801) 203-0290

Fax

(801) 872-4329

NPI assigned

Jun 29, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Mark Spencer McGowan, DMDNPI 1659661288

Title

Owner

Phone

(801) 203-0290

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Mark Spencer McGowan, D.M.D.

  • General Practice Dentistry
  • Bountiful, UT
  • NPI 1659661288
  NPD (past) Authorized official

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

{
    "created_epoch": "1498694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1508387564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 MEDICAL DR STE A200",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840104970",
            "telephone_number": "801-203-0290",
            "fax_number": "801-872-4329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 MEDICAL DR STE A200",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840104970",
            "telephone_number": "801-203-0290",
            "fax_number": "801-872-4329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOUNTIFUL RIDGE DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-29",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MCGOWAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "SPENCER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-203-0290",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "8008797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bountiful Oral Surgery, P.C.
• Bountiful PDC PLLC (Asay Dentistry)
• Bountiful Pediatrics and Neonatology Inc
• Bountiful Radiology Associates Inc
• Bountiful Ridge Anesthesia, PLLC
• Bountiful Surgery Center LLC
• Bountiful Surgical Associates
• Bountiful Vision Plaza PC
• Kelly Bowen, LCSW
• Maeve Bowen

• General Practice Dentistry in Bountiful, UT
• Providers in Bountiful, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.