Active NPI
Micah Weisenberg, DDS
- Dentist
- Midvale, UT
National Provider Identifier
1588049233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10757585-9922
- Practice address
- 1144 E Fort Union Blvd
Midvale, UT 84047 - Phone
- (801) 566-3118
- NPI assigned
- Jul 23, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 15995 | MD | |
| Dentist | 122300000X | 10757585-9922 | UT | Primary |
Addresses
Primary practice location
1144 E Fort Union Blvd
Midvale, UT 84047
Mailing address
1235 E Wilmington Ave Apt 317
Salt Lake City, UT 84106-4265
Phone (301) 661-1459
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midvale Modern Dentistry, LLP | General Practice | 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.
-
- General Practice Dentistry
- Midvale, UT
- NPI 1407112469
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437609600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1526947200000",
"number": "1588049233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1235 E WILMINGTON AVE APT 317",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841064265",
"telephone_number": "301-661-1459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1144 E FORT UNION BLVD",
"city": "MIDVALE",
"state": "UT",
"postal_code": "84047",
"telephone_number": "801-566-3118"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEISENBERG",
"first_name": "MICAH",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-07-23",
"last_updated": "2018-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MD",
"license": "15995",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "UT",
"license": "10757585-9922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Midvale, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.