Mountain Sky Dental LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

MOUNTAIN SKY DENTAL LLC

Practice address

5640 South Wasatch Dr Ste a
So. Ogden, UT 84403

Phone

(385) 244-1530

Fax

(385) 244-1530

NPI assigned

Jun 5, 2021

Last updated

Jun 5, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

MOUNTAIN SKY DENTAL LLCAs reported in NPPES

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

Authorized official

Name

Randall J Kelley, DMD

Title

Owner

Phone

(385) 244-1530

Specialties & licenses 1

Addresses

Part of

Mountain Sky Dental LLC

Locations

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

{
    "created_epoch": "1622851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622851200000",
    "number": "1720655194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5640 SOUTH WASATCH DR STE A",
            "city": "SO. OGDEN",
            "state": "UT",
            "postal_code": "84403",
            "telephone_number": "385-244-1530",
            "fax_number": "385-244-1530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5640 SOUTH WASATCH DR STE A",
            "city": "SO. OGDEN",
            "state": "UT",
            "postal_code": "84403",
            "telephone_number": "385-244-1530",
            "fax_number": "385-244-1530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN SKY DENTAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNTAIN SKY DENTAL LLC",
        "enumeration_date": "2021-06-05",
        "last_updated": "2021-06-05",
        "certification_date": "2021-06-05",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "385-244-1530",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Machel Knowles, C.N.M.
• Donald W Sorensen, DDS

• Dentist in So Ogden, UT
• Providers in So Ogden, UT by specialty
• Dentist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2021; 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.