Kidz Dental Works

Primary specialty

DentistTaxonomy code 122300000X

License

266402 Issued in UT

Legal business name

KIDZ DENTAL WORKS

Practice address

780 S 2000 W
BLDG F2
Syracuse, UT 84075

Phone

(801) 776-8176

Fax

(801) 774-9085

NPI assigned

Feb 20, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Gary Scott Wall, DDS

Title

Owner

Phone

(801) 776-8176

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1730224643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 S 2000 W",
            "address_2": "BLDG F2",
            "city": "SYRACUSE",
            "state": "UT",
            "postal_code": "84075",
            "telephone_number": "801-776-8176",
            "fax_number": "801-774-9085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 S 2000 W",
            "address_2": "BLDG F2",
            "city": "SYRACUSE",
            "state": "UT",
            "postal_code": "84075",
            "telephone_number": "801-776-8176",
            "fax_number": "801-774-9085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDZ DENTAL WORKS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2008-07-14",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-776-8176",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "UT",
            "license": "266402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528902470008",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Johnson, CSW
• Anna Ruth Kalmar
• Dylan Kaminske
• Max G Karabachian
• Kids Town Pediatric Dentistry of Syracuse
• Jordan B Killpack, MC, LPC, CMHC
• Julie Ann Knopp, CSW
• Amber Lynne Kreiser
• Jerin H Lake
• Lakeshore Counseling

• Dentist in Syracuse, UT
• Providers in Syracuse, UT by specialty
• Dentist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; 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.