Individual provider Active NPI

Joseph G Mirci, DDS, MAGD

  • General Practice Dentistry
  • Salt Lake City, UT
National Provider Identifier
1730100710
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
83-140890-992 Issued in UT
Practice address
2090 E 2100 S
Salt Lake City, UT 84109-1100
Phone
(801) 487-3836
Fax
(801) 487-7210
NPI assigned
Jul 22, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 83-140890-992 UT Primary

Addresses

Primary practice location

2090 E 2100 S
Salt Lake City, UT 84109-1100

Mailing address

2090 E 2100 S
Salt Lake City, UT 84109-1100
Phone (801) 487-3836

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150122002452 UT Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 5193049112

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
83-140890-992UTMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730100710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2090 E 2100 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841091100",
            "telephone_number": "801-487-3836",
            "fax_number": "801-487-7210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2090 E 2100 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841091100",
            "telephone_number": "801-487-3836",
            "fax_number": "801-487-7210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRCI",
        "first_name": "JOSEPH",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "DDS, MAGD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "83-140890-992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.