Active NPI
Jake Richardson, D.M.D.
- General Practice Dentistry
- Fort Duchesne, UT
National Provider Identifier
1568024347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 11308205-9921
- Practice address
- 6932 E 1400 S
Fort Duchesne, UT 84026 - Phone
- (435) 722-5122
- NPI assigned
- Jul 2, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 11308205-9921 | UT | Primary |
Addresses
Primary practice location
6932 E 1400 S
Fort Duchesne, UT 84026
Mailing address
412 E 2500 N
Vernal, UT 84078-9595
Phone (435) 828-8801
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11308205-9921 | UT | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dhew Ind HLTH SV HLTH SVS&Mntal HLTH Adm | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federal Public Health Clinic/Center
- Fort Duchesne, UT
- NPI 1508887993
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562025600000",
"number": "1568024347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "412 E 2500 N",
"city": "VERNAL",
"state": "UT",
"postal_code": "840789595",
"telephone_number": "435-828-8801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6932 E 1400 S",
"city": "FORT DUCHESNE",
"state": "UT",
"postal_code": "84026",
"telephone_number": "435-722-5122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHARDSON",
"first_name": "JAKE",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-07-02",
"last_updated": "2019-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "UT",
"license": "11308205-9921",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Duchesne, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.