Family Dental Care

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

FAMILY DENTAL CARE

Practice address

2500 S State St # 404
South Salt Lake, UT 84115-3164

Phone

(385) 646-4747

Fax

(385) 646-4348

NPI assigned

Feb 15, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Tanner M. Clark, DMDNPI 1679841811

Title

Director/Manager/Dentist

Phone

(208) 317-8555

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tanner Mark Clark, D.M.D.

  • General Practice Dentistry
  • Philadelphia, PA
  • NPI 1679841811
  NPD (past) Authorized official

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

{
    "created_epoch": "1581724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581724800000",
    "number": "1578196861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10597 S BEACH COMBER WAY",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840096132",
            "telephone_number": "208-317-8555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 S STATE ST # 404",
            "city": "SOUTH SALT LAKE",
            "state": "UT",
            "postal_code": "841153164",
            "telephone_number": "385-646-4747",
            "fax_number": "385-646-4348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-15",
        "last_updated": "2020-02-15",
        "certification_date": "2020-02-15",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "TANNER",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "DIRECTOR/MANAGER/DENTIST",
        "authorized_official_telephone_number": "208-317-8555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679841811",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diana B Escobar, CPSS
• Nathan James Ewell, MASSAGE THERAPIST
• Jessica Lea Eyink, PT
• Ezra 1St Medical
• Jessica Fairbanks, CPSS
• Family First Home Care, LLC
• Tyler Scott Farnsworth, PMHNP-BC
• Nicole Feigt, ED.S, MS
• Armani Elizabeth Fields
• Nicole Flack, SLP

• General Practice Dentistry in South Salt Lake, UT
• Providers in South Salt Lake, 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 Feb 15, 2020; 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.