Active NPI
Mark D. McKell, D.D.S.
- General Practice Dentistry
- Provo, UT
National Provider Identifier
1629178728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 144960-9921
- Practice address
- 777 N 500 W
# 204
Provo, UT 84601-1541 - Phone
- (801) 374-2182
- Fax
- (801) 374-0130
- NPI assigned
- Sep 25, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 144960-9921 | UT | Primary |
Addresses
Primary practice location
777 N 500 W
# 204
Provo, UT 84601-1541
Mailing address
777 N 500 W
# 204
Provo, UT 84601-1541
Phone (801) 374-2182
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 144960-9921 | UT | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Provo Premier Dental Group PLLC | General Practice | Past | Accepting new patients |
| MP Dental LLC | General Practice | Past | Accepting new patients |
Organizations & group practices 2
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
- Proud, UT
- NPI 1346723319
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1629178728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "777 N 500 W",
"address_2": "# 204",
"city": "PROVO",
"state": "UT",
"postal_code": "846011541",
"telephone_number": "801-374-2182",
"fax_number": "801-374-0130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "777 N 500 W",
"address_2": "# 204",
"city": "PROVO",
"state": "UT",
"postal_code": "846011541",
"telephone_number": "801-374-2182",
"fax_number": "801-374-0130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKELL",
"first_name": "MARK",
"middle_name": "D.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "UT",
"license": "144960-9921",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.