Wasatch Dental Association, P.C.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

144526 Issued in UT

Legal business name

WASATCH DENTAL ASSOCIATION, P.C.

Practice address

1245 Capitol St
Suite 106-S
Ogden, UT 84401-2847

Phone

(801) 394-0401

Fax

(801) 394-0644

NPI assigned

Oct 27, 2010

Last updated

Oct 27, 2010By 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

Laurence R Palmer, D.D.S.NPI 1902921703

Title

Owner

Phone

(801) 394-0401

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Laurence R Palmer, D.D.S.

  • General Practice Dentistry
  • Ogden, UT
  • NPI 1902921703
  NPD (past) Authorized official

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

{
    "created_epoch": "1288137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288137600000",
    "number": "1639479488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 CAPITOL ST",
            "address_2": "SUITE 106-S",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844012847",
            "telephone_number": "801-394-0401",
            "fax_number": "801-394-0644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 CAPITOL ST",
            "address_2": "SUITE 106-S",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844012847",
            "telephone_number": "801-394-0401",
            "fax_number": "801-394-0644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASATCH DENTAL ASSOCIATION, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-27",
        "last_updated": "2010-10-27",
        "status": "A",
        "authorized_official_last_name": "PALMER",
        "authorized_official_first_name": "LAURENCE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-394-0401",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "UT",
            "license": "144526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "518883937000",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shayley Marie Warner, CMHC
• Cyrus Mace Warren, LCSW
• Jonathan Randall Warren, PHARMD
• Teresa Lee Warwood, APRN
• Wasatch Advanced Dental Care LLC
• Wasatch Dermatology, PC
• Wasatch Physical and Rehabilitation Medicine, P.C.
• Wasatch Podiatry PLLC
• Wasatch Post-Acute Services
• Wasatch RPM LLC

• Dental Clinic/Center in Ogden, UT
• Providers in Ogden, 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 Oct 27, 2010; 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.