Wasatch Dental Group LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

WASATCH DENTAL GROUP LLC

Practice address

1685 W Towne Center Dr
South Jordan, UT 84095-8697

Phone

(801) 254-7003

Fax

(801) 281-8455

NPI assigned

May 26, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Dane J Nelson, DMDNPI 1114377744

Title

Owner/Partner/Dentist

Phone

(801) 254-7003

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Oquirrh Mountain Dental Doing business as

Electronic endpoints 1

Locations

Practitioners 1

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

• Dane Joseph Nelson, D.M.D.

  • General Practice Dentistry
  • Salt Lake City, UT
  • NPI 1114377744
  NPD Authorized official

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

{
    "created_epoch": "1590451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590451200000",
    "number": "1700409695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1685 W TOWNE CENTER DR",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840958697",
            "telephone_number": "801-254-7003",
            "fax_number": "801-281-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1685 W TOWNE CENTER DR",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840958697",
            "telephone_number": "801-254-7003",
            "fax_number": "801-281-8455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASATCH DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-26",
        "last_updated": "2020-05-26",
        "certification_date": "2020-05-26",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "DANE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/PARTNER/DENTIST",
        "authorized_official_telephone_number": "801-254-7003",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1164883104",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "mb.oquirrhmtndental@gmail.com",
            "affiliation": "N",
            "address_1": "1685 W Towne Center Dr",
            "city": "South Jordan",
            "state": "UT",
            "country_code": "US",
            "postal_code": "840958697",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Oquirrh Mountain Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laci Warby, LCSW
• Neil P Wardle, SAC
• Madison Wareham
• Catrina Warner, COTA-L
• Sydney Case Warren, PHYSICIAN ASSISTANT
• Wasatch Pain Solutions, PC
• Wasatch Pro Monitoring LLC
• Wasatch Tech Iom LLC
• Wasatch View Eye and Laser Clinic LLC
• Wasatch View Eye Care L L C

• General Practice Dentistry in South Jordan, UT
• Providers in South Jordan, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2020; 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.