NPIMap

Organization Active NPI

Wisdom Teeth Only

  • Dentist
  • Provo, UT
National Provider Identifier
1528518909
Registry record updated Oct 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5136597 Issued in UT
Legal business name
WISDOM TEETH ONLY
Practice address
2230 N University Pkwy Ste 8a
Provo, UT 84604-6702
Phone
(801) 370-0050
Fax
(801) 370-9635
NPI assigned
Oct 10, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2016

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

Authorized official

Name
Ms. Elizabeth Garcia
Title
Office Manager
Phone
(801) 370-0050

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 5136597 UT Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 134055 UT
Clinical Nurse SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 364S00000X 187982 UT
Clinical Nurse SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 364S00000X 5594772 UT

Addresses

Primary practice location

2230 N University Pkwy Ste 8a
Provo, UT 84604-6702

Mailing address

2230 N University Pkwy Ste 8a
Provo, UT 84604-6702
Phone (801) 370-0050

Other names 1

  • Dr. Wisdom Teeth Other name

National Provider Directory

National Provider Directory
Tax ID family
Dr Heath Hendrickson3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1476057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476057600000",
    "number": "1528518909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2230 N UNIVERSITY PKWY STE 8A",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846046702",
            "telephone_number": "801-370-0050",
            "fax_number": "801-370-9635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2230 N UNIVERSITY PKWY STE 8A",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846046702",
            "telephone_number": "801-370-0050",
            "fax_number": "801-370-9635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISDOM TEETH ONLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-10",
        "last_updated": "2016-10-10",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "801-370-0050",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "UT",
            "license": "5136597",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "UT",
            "license": "134055",
            "primary": false
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist",
            "state": "UT",
            "license": "187982",
            "primary": false
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist",
            "state": "UT",
            "license": "5594772",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Wisdom Teeth",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2016; 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.