NPIMap

Organization Active NPI

Schweppe Pediatric Dental

  • Pediatric Dentistry
  • South Ogden, UT
National Provider Identifier
1710545769
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
SCHWEPPE PEDIATRIC DENTAL
Practice address
5685 S 1475 E Ste 3a
South Ogden, UT 84403-4598
Phone
(801) 479-9220
Fax
(801) 479-0837
NPI assigned
Jun 4, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Authorized official

Name
Mathew D Schweppe, DDSNPI 1215964234
Title
Owner
Phone
(801) 479-9220

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
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

5685 S 1475 E Ste 3a
South Ogden, UT 84403-4598

Mailing address

5685 S 1475 E Ste 3a
South Ogden, UT 84403-4598
Phone (801) 479-9220

Other practice location 1

1320 N 600 E Ste 2
Logan, UT 84341-2474
Phone (435) 752-0775

Other practice location 2

2850 N 2000 W Ste 205
Farr West, UT 84404-9230
Phone (801) 479-9220

Other identifiers 2

IdentifierTypeStateIssuer
1141007-00MedicaidWY
517747532013MedicaidUT

National Provider Directory

National Provider Directory

Locations

5685 S 1475 E
Ste 3A
South Ogden, UT 84403
Phone (801) 479-9220

Practitioners & affiliated clinicians

Practitioners 4

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": "1559606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1710545769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5685 S 1475 E STE 3A",
            "city": "SOUTH OGDEN",
            "state": "UT",
            "postal_code": "844034598",
            "telephone_number": "801-479-9220",
            "fax_number": "801-479-0837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5685 S 1475 E STE 3A",
            "city": "SOUTH OGDEN",
            "state": "UT",
            "postal_code": "844034598",
            "telephone_number": "801-479-9220",
            "fax_number": "801-479-0837"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1320 N 600 E Ste 2",
            "address_purpose": "LOCATION",
            "city": "Logan",
            "state": "UT",
            "postal_code": "843412474",
            "country_code": "US",
            "telephone_number": "435-752-0775",
            "fax_number": "801-479-0837",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2850 N 2000 W Ste 205",
            "address_purpose": "LOCATION",
            "city": "Farr West",
            "state": "UT",
            "postal_code": "844049230",
            "country_code": "US",
            "telephone_number": "801-479-9220",
            "fax_number": "801-479-0837",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SCHWEPPE PEDIATRIC DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-04",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "SCHWEPPE",
        "authorized_official_first_name": "MATHEW",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-479-9220",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1141007-00",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "517747532013",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Ogden, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.