Active NPI
Jacob Daniel Reynolds
- General Practice Dentistry
- SLC, UT
National Provider Identifier
1710679386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 13403126-9923
- Practice address
- 2090 E 2100 S
SLC, UT 84109-1152 - Phone
- (801) 486-1155
- NPI assigned
- May 23, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 13403126-9923 | UT | Primary |
Addresses
Primary practice location
2090 E 2100 S
SLC, UT 84109-1152
Mailing address
2341 E John Holladay CT
Holladay, UT 84117-4628
Phone (801) 608-5664
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13403126-9923 | UT | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725408000000",
"number": "1710679386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2341 E JOHN HOLLADAY CT",
"city": "HOLLADAY",
"state": "UT",
"postal_code": "841174628",
"telephone_number": "801-608-5664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2090 E 2100 S",
"city": "SLC",
"state": "UT",
"postal_code": "841091152",
"telephone_number": "801-486-1155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "JACOB",
"middle_name": "DANIEL",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-23",
"last_updated": "2024-09-04",
"certification_date": "2024-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "UT",
"license": "13403126-9923",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in SLC, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.