Park City PDC PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

352590747 Issued in UT

Legal business name

PARK CITY PDC PLLC

Practice address

1729 Sidewinder Dr.
Ste 102
Park City, UT 84060-7518

Phone

(435) 649-9492

Fax

(801) 692-9083

NPI assigned

May 22, 2017

Organization subpart

No

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

Authorized official

Name

Jacob Warner

Title

Credentialing Manager

Phone

(801) 691-1701

Specialties & licenses 1

Addresses

Other names 1

• Snow Country Dental Care Doing business as

Locations

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

{
    "created_epoch": "1495411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625184000000",
    "number": "1669909511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 970309",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840970309",
            "telephone_number": "801-691-1701",
            "fax_number": "801-335-6551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1729 SIDEWINDER DR.",
            "address_2": "STE 102",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840607518",
            "telephone_number": "435-649-9492",
            "fax_number": "801-692-9083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK CITY PDC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-22",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A",
        "authorized_official_last_name": "WARNER",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "801-691-1701"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "UT",
            "license": "352590747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Snow Country Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Park City Healthcare, PC
• Park City Imaging, Inc.
• Park City Internal Medicine - Pediatrics, LC
• Park City Market Inc
• Park City Medical Center
• Park City Pediatric Dentistry
• Park City Pediatric Dentistry
• Park City Surgery Center LLC
• Park City Vision Center, Inc.
• Katharine Parker, RDN, CNSC, CD

• Dental Clinic/Center in Park City, UT
• Providers in Park City, 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 Jul 2, 2021; 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.