West Jordan PDC LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7702761-9922 Issued in UT

Legal business name

WEST JORDAN PDC LLC

Practice address

7555 Center View CT
Ste 104
West Jordan, UT 84084

Phone

(801) 566-8540

Fax

(801) 282-5114

NPI assigned

May 21, 2015

Organization subpart

No

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

Authorized official

Name

Jacob Warner

Title

Credentialing Manager

Phone

(801) 691-1701

Specialties & licenses 1

Addresses

Other names 1

• Platinum Dental Care Doing business as

Locations

Practitioners 1

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

• Kenneth S.J. Hicks, D.M.D

  • General Practice Dentistry
  • West Jordan, UT
  • NPI 1689858581
  NPD (past)

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

{
    "created_epoch": "1432166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625529600000",
    "number": "1588043780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 970874",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840970687",
            "telephone_number": "801-691-1701",
            "fax_number": "801-335-6551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7555 CENTER VIEW CT",
            "address_2": "STE 104",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "84084",
            "telephone_number": "801-566-8540",
            "fax_number": "801-282-5114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST JORDAN PDC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-21",
        "last_updated": "2021-07-06",
        "certification_date": "2021-07-06",
        "status": "A",
        "authorized_official_last_name": "WARNER",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "801-691-1701"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "7702761-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Platinum Dental Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Platinum Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rhiann Werley
• West Jordan Care Center
• West Jordan Family Medicine, LLC
• West Jordan Medical Center PC
• West Jordan Modern Dentistry , LLP
• West Jordan Smile Center
• West Jordan Smile Center
• West Ridge Academy
• West Valley Dental Group Inc
• Hailey West

• General Practice Dentistry in West Jordan, UT
• Providers in West Jordan, 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 Jul 6, 2021; 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.