NPIMap

Organization Active NPI

Canyon Dental Group LLC

  • General Practice Dentistry
  • Ogden, UT
National Provider Identifier
1669887204
Registry record updated Jun 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
140299 Issued in UT
Legal business name
CANYON DENTAL GROUP LLC
Practice address
512 12TH St
Ogden, UT 84404-5803
Phone
(801) 399-5831
Fax
(801) 409-0134
NPI assigned
Jun 23, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2014

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

Authorized official

Name
Dr. Bart Wilson Wolthuis, DDSNPI 1023150679
Title
Dr.
Phone
(801) 399-5831

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 140299 UT Primary

Addresses

Primary practice location

512 12TH St
Ogden, UT 84404-5803

Mailing address

512 12TH St
Ogden, UT 84404-5803
Phone (801) 399-5831

National Provider Directory

National Provider Directory

Locations

512 12th St
Ogden, UT 84404
Phone (801) 399-5831

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1403481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403481600000",
    "number": "1669887204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 12TH ST",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844045803",
            "telephone_number": "801-399-5831",
            "fax_number": "801-409-0134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 12TH ST",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844045803",
            "telephone_number": "801-399-5831",
            "fax_number": "801-409-0134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-23",
        "last_updated": "2014-06-23",
        "status": "A",
        "authorized_official_last_name": "WOLTHUIS",
        "authorized_official_first_name": "BART",
        "authorized_official_middle_name": "WILSON",
        "authorized_official_title_or_position": "DR.",
        "authorized_official_telephone_number": "801-399-5831",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "140299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ogden, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2014; 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.