MDG - Nephi Dental, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

MDG - NEPHI DENTAL, LLC

Doing business as

Bear Canyon Dental

Practice address

490 N Main St
Nephi, UT 84648-1102

Phone

(435) 623-1918

NPI assigned

May 12, 2023

Last updated

May 12, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Carley Leann Herrick

Title

Attorney

Phone

(801) 726-6836

Specialties & licenses 1

Addresses

Other names 1

• Bear Canyon Dental 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, and the practitioner matching its NPPES authorized official.

• Douglas A Petersen, D.M.D.

  • Dentist
  • Nephi, UT
  • NPI 1003942335
  NPD (past)

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

{
    "created_epoch": "1683849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683849600000",
    "number": "1609566538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "490 N MAIN ST",
            "city": "NEPHI",
            "state": "UT",
            "postal_code": "846481102",
            "telephone_number": "435-623-1918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 N MAIN ST",
            "city": "NEPHI",
            "state": "UT",
            "postal_code": "846481102",
            "telephone_number": "435-623-1918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MDG - NEPHI DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-12",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-12",
        "status": "A",
        "authorized_official_last_name": "HERRICK",
        "authorized_official_first_name": "CARLEY",
        "authorized_official_middle_name": "LEANN",
        "authorized_official_title_or_position": "ATTORNEY",
        "authorized_official_telephone_number": "801-726-6836",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bear Canyon Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Terrie Marie Kouns
• Jana Larsen, COTA/L
• Shelly Lebaron
• Melyn Lund
• Emily Mae Magallanes, MD
• Taija Mecham
• Tyler Nathan Memmott, CRNA
• Shaunna Meredith
• McKay Faith Meyer
• Rachel Burton Morrell, BSN, RN, IBCLC

• Dental Clinic/Center in Nephi, UT
• Providers in Nephi, 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 May 12, 2023; 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.