NPIMap

Organization Active NPI

Modern Dental Professionals - Utah, PC

Doing business as Monarch Dental - West Valley

  • Dentist
  • West Valley, UT
National Provider Identifier
1720485709
Registry record updated Apr 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
MODERN DENTAL PROFESSIONALS - UTAH, PC
Doing business as
Monarch Dental - West Valley
Practice address
4645 S 4000 W Ste B
West Valley, UT 84120-6250
Phone
(801) 955-1900
Fax
(801) 955-8300
NPI assigned
Nov 19, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2024

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

Authorized official

Name
Liliana Martinez
Title
Credentialing Director
Phone
(949) 308-9792

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

4645 S 4000 W Ste B
West Valley, UT 84120-6250

Mailing address

4645 S 4000 W Ste B
West Valley, UT 84120-6250
Phone (801) 955-1900

Other names 1

  • Monarch Dental - West Valley Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Modern Dental Professionals Utah PC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4645 S 4000 W
Ste B
West Valley City, UT 84120
Phone (216) 264-6804

Practitioners & affiliated clinicians

Practitioners 3

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": "1416355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712534400000",
    "number": "1720485709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4645 S 4000 W STE B",
            "city": "WEST VALLEY",
            "state": "UT",
            "postal_code": "841206250",
            "telephone_number": "801-955-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4645 S 4000 W STE B",
            "city": "WEST VALLEY",
            "state": "UT",
            "postal_code": "841206250",
            "telephone_number": "801-955-1900",
            "fax_number": "801-955-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS - UTAH, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-19",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "LILIANA",
        "authorized_official_title_or_position": "CREDENTIALING DIRECTOR",
        "authorized_official_telephone_number": "949-308-9792"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monarch Dental - West Valley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Valley, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 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.

Verify at the official NPI Registry.