Salt Lake Pediatric Dentistry

Primary specialty

DentistTaxonomy code 122300000X

License

6273877 Issued in UT

Legal business name

SALT LAKE PEDIATRIC DENTISTRY

Practice address

1548 E 4500 S Ste 102
Salt Lake City, UT 84117-5209

Phone

(801) 463-1900

NPI assigned

Aug 1, 2014

Last updated

Aug 1, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jeffrey Rupp

Title

Owner

Phone

(801) 463-1900

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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.

• Jeffery K. Rupp, D.M.D., M.S.

  • Pediatric Dentistry
  • Salt Lake City, UT
  • NPI 1720149453
  NPD (past)

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

{
    "created_epoch": "1406851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406851200000",
    "number": "1538577655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1548 E 4500 S STE 102",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841175209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1548 E 4500 S STE 102",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841175209",
            "telephone_number": "801-463-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALT LAKE PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-01",
        "last_updated": "2014-08-01",
        "status": "A",
        "authorized_official_last_name": "RUPP",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-463-1900",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "7348465",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "6273877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Salt Lake Modern Dentistry, LLP
• Salt Lake Occupational Therapy, LLC
• Salt Lake Operations, LLC (Life Care Center of Salt Lake City)
• Salt Lake Orthopaedic Specialist, LLC (Salt Lake Orthopaedic Clinic)
• Salt Lake Pedia Center Inc
• Salt Lake Podiatry Center PLLC
• Salt Lake Region Neurosurgery LLC
• Salt Lake Regional Medical Center LP (Salt Lake Regional Medical Center)
• Salt Lake Regional Medical Center LP (Salt Lake Regional Medical Center)
• Salt Lake Regional Medical Center LP (Salt Lake Regional Medical Center)

• Dentist in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Dentist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2014; 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.