Easy Wisdom Teeth LLC

Primary specialty

DentistTaxonomy code 122300000X

License

275551-9922 Issued in UT

Legal business name

EASY WISDOM TEETH LLC

Practice address

2222 W 3500 S
A1
West Valley City, UT 84119-3464

Phone

(801) 886-3379

NPI assigned

Oct 10, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Ken John Marz, DDS

Title

Owner

Phone

(801) 886-3379

Specialties & licenses 1

Addresses

Other names 1

• Easy Wisdom Teeth Other name

Locations

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

{
    "created_epoch": "1412899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412899200000",
    "number": "1568866119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 W 3500 S",
            "address_2": "A1",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841193464",
            "telephone_number": "801-886-3379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 W 3500 S",
            "address_2": "A1",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841193464",
            "telephone_number": "801-886-3379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASY WISDOM TEETH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-10",
        "last_updated": "2014-10-10",
        "status": "A",
        "authorized_official_last_name": "MARZ",
        "authorized_official_first_name": "KEN",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-886-3379",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "UT",
            "license": "275551-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Easy Wisdom Teeth",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Shannon Quinn Dunlop, APRN
• Adler Dunning
• Katarina Dushku
• Jane M. Dyer, CNM
• Michelle Samantha Easthope
• Edward G. Southwick, M.D., P.C.
• Clare D Eggett, NP
• Nadia Ekenstam, LCSW
• Ryan Clark Eldredge
• Lily Ellis

• Dentist in West Valley City, UT
• Providers in West Valley City, UT by specialty
• Dentist in Utah

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