Eastgate Pediatric Dentistry

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

EASTGATE PEDIATRIC DENTISTRY

Practice address

1580 E 3900 S
Suite #110
SLC, UT 84124-1581

Phone

(801) 272-8555

NPI assigned

Dec 18, 2013

Organization subpart

No

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

Authorized official

Name

Marci Nicol

Title

VP of Operations

Phone

(801) 918-4135

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Jeanne Ann Hibler, DDS

  • Pediatric Dentistry
  • Salt Lake, UT
  • NPI 1609883677
  NPD (past)

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

{
    "created_epoch": "1387324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387324800000",
    "number": "1629499520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1580 E 3900 S",
            "address_2": "SUITE #110",
            "city": "SLC",
            "state": "UT",
            "postal_code": "841241581",
            "telephone_number": "801-272-8555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1580 E 3900 S",
            "address_2": "SUITE #110",
            "city": "SLC",
            "state": "UT",
            "postal_code": "841241581",
            "telephone_number": "801-272-8555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTGATE PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-18",
        "last_updated": "2013-12-18",
        "status": "A",
        "authorized_official_last_name": "NICOL",
        "authorized_official_first_name": "MARCI",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "801-918-4135"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vera Helene Draper, M.S., CCC-A
• Adrienne Dunlap
• Olga Quinonez Eames
• Holly R Earl
• Earth and Sky Acupuncture
• Matthew Easthope
• Aileen Gayle Edwards, RN/BSN
• Amy Deforest Edwards, ACMHC
• Kailee Edwards, DO
• Tiffany Edwards

• Dental Clinic/Center in SLC, UT
• Providers in SLC, 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 Dec 18, 2013; 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.