Derek Christopher Funk, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

31378 Issued in TX

Practice address

1345 E 3900 S
Suite 108
Salt Lake City, UT 84124-1474

Phone

(801) 274-3768

Fax

(801) 273-9768

NPI assigned

Aug 2, 2010

Last updated

Jun 30, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Derek C Funk DDS PC

  • General Practice Dentistry
  • Sweeny, TX
  • NPI 1528589314
  Authorized official Same address or phone
• Daniel M Cohen DMD PC

  • Dental Clinic/Center
  • Salt Lake City, UT
  • NPI 1134709488
  NPD (past)

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

{
    "created_epoch": "1280707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1498780800000",
    "number": "1558675512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 N MCKINNEY ST",
            "address_2": "SUITE A",
            "city": "SWEENY",
            "state": "TX",
            "postal_code": "77480",
            "telephone_number": "979-548-2184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1345 E 3900 S",
            "address_2": "SUITE 108",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841241474",
            "telephone_number": "801-274-3768",
            "fax_number": "801-273-9768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNK",
        "first_name": "DEREK",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-02",
        "last_updated": "2017-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "7702857-9921",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "31378",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Functionally Integrative Therapy LLC
• Camille Manyan Fung, MD
• Christopher Funk, DPM
• Daniel Shawn Funk, DMD
• Deborah Gay Funk
• K. Christopher Funk Jr., DMD
• Sydnee Funk
• Taylor Funk
• John Henry Funke, RN
• Theresa Furbish

• General Practice Dentistry in Salt Lake City, UT
• Providers in Salt Lake City, 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 Jun 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.