Pony Express Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

5015649 Issued in UT

Legal business name

PONY EXPRESS DENTAL LLC

Practice address

1308 E. Eagle Mountain Blvd
Eagle Mountain, UT 84005

Phone

(801) 876-7669

NPI assigned

Feb 14, 2017

Organization subpart

Yes

Parent organization

LAKE MOUNTAIN HEALTH, LLCAs reported in NPPES

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

Authorized official

Name

Dr. Michael S Tornow, DMD

Title

Coo

Phone

(505) 947-4252

Specialties & licenses 1

Addresses

Practitioners 1

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

• Andrew Mark Bateman, DMD

  • General Practice Dentistry
  • Lehi, UT
  • NPI 1174052849
  NPD (past)

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

{
    "created_epoch": "1487030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489622400000",
    "number": "1609315480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 E 12300 S",
            "address_2": "SUITE I-5",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840206970",
            "telephone_number": "801-789-7669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1308 E. EAGLE MOUNTAIN BLVD",
            "city": "EAGLE MOUNTAIN",
            "state": "UT",
            "postal_code": "84005",
            "telephone_number": "801-876-7669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONY EXPRESS DENTAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKE MOUNTAIN HEALTH, LLC",
        "enumeration_date": "2017-02-14",
        "last_updated": "2017-03-16",
        "status": "A",
        "authorized_official_last_name": "TORNOW",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "505-947-4252",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "UT",
            "license": "5015649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pioneer Drug LLC
• Hailee Platt
• Podera Therapy PLLC
• Sienna J Pollard, LMT
• Brian J Pontius, MPAS PA-C
• Samantha Nicole Postak
• Premier Family Medical - City Center
• Premier Family Medical - Eagle Mountain
• Kacie Preysz, OT
• Elizabeth A Pritt, PA-C

• Dental Clinic/Center in Eagle Mountain, UT
• Providers in Eagle Mountain, UT by specialty
• Dental Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2017; 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.