NPIMap

Organization Active NPI

College Dental Clinic LLC

  • Dental Clinic/Center
  • Orem, UT
National Provider Identifier
1720465875
Registry record updated Apr 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
9317729 Issued in UT
Legal business name
COLLEGE DENTAL CLINIC LLC
Practice address
1176 S 1480 W
Orem, UT 84058-4905
Phone
(801) 426-0774
NPI assigned
Apr 28, 2015
Last updated
Apr 28, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2015

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

Authorized official

Name
Kenneth Molen, DDSNPI 1376746628
Title
Owner
Phone
(801) 426-0774

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 9317729 UT Primary

Addresses

Primary practice location

1176 S 1480 W
Orem, UT 84058-4905

Mailing address

1176 S 1480 W
Orem, UT 84058-4905
Phone (801) 426-0774

National Provider Directory

National Provider Directory

Locations

1176 S 1480 W
Orem, UT 84058
Phone (801) 426-0774

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1430179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430179200000",
    "number": "1720465875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1176 S 1480 W",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840584905",
            "telephone_number": "801-426-0774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1176 S 1480 W",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840584905",
            "telephone_number": "801-426-0774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEGE DENTAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-28",
        "last_updated": "2015-04-28",
        "status": "A",
        "authorized_official_last_name": "MOLEN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-426-0774",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "UT",
            "license": "9317729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orem, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2015; 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.