Jordan Landing Pediatrics

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

JORDAN LANDING PEDIATRICS

Practice address

7613 Jordan Landing Blvd
Ste 210
West Jordan, UT 84084-1972

Phone

(801) 280-9595

Fax

(801) 280-1169

NPI assigned

Aug 31, 2010

Organization subpart

No

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

Authorized official

Name

Dr. R Ryan Johansen, D.D.S.

Title

Doctor

Phone

(801) 280-9595

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1283212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283212800000",
    "number": "1528374337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7613 JORDAN LANDING BLVD",
            "address_2": "STE 210",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840841972",
            "telephone_number": "801-280-9595",
            "fax_number": "801-280-1169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7613 JORDAN LANDING BLVD",
            "address_2": "STE 210",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840841972",
            "telephone_number": "801-280-9595",
            "fax_number": "801-280-1169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JORDAN LANDING PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-31",
        "last_updated": "2010-08-31",
        "status": "A",
        "authorized_official_last_name": "JOHANSEN",
        "authorized_official_first_name": "R",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "801-280-9595",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002204002",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528451522009",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jordan Health Associates, Inc.
• Jordan Landing Dental Care, PC
• Jordan Landing Dental Management
• Jordan Landing Family Medicine LLC
• Jordan Landing Pediatric Dentistry DDS
• Jordan River Women'S Health, P.C.
• Jordan Valley & Mountain Point Medical Center, LLC
• Jordan Valley & Mountain Point Medical Center, LLC
• Jordan Valley Dental
• Jordan Valley Dermatology Center LLC

• Periodontics in West Jordan, UT
• Providers in West Jordan, UT by specialty
• Periodontics in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2010; 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.