Active NPI
Clark Keith Taylor II, DDS
- Pediatric Dentistry
- Bountiful, UT
National Provider Identifier
1750947735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 11488542-9923
- Practice address
- 535 Medical Dr
Bountiful, UT 84010-4929 - Phone
- (801) 292-2828
- NPI assigned
- May 14, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 11488542-9923 | UT | Primary |
Addresses
Primary practice location
535 Medical Dr
Bountiful, UT 84010-4929
Mailing address
535 Medical Dr
Bountiful, UT 84010-4929
Phone (801) 292-2828
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190802002309 | CT | Order and Referring Only - Dentist | 6103153820 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11488542-9923 | UT | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637107200000",
"number": "1750947735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "535 MEDICAL DR",
"city": "BOUNTIFUL",
"state": "UT",
"postal_code": "840104929",
"telephone_number": "801-292-2828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "535 MEDICAL DR",
"city": "BOUNTIFUL",
"state": "UT",
"postal_code": "840104929",
"telephone_number": "801-292-2828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAYLOR",
"first_name": "CLARK",
"middle_name": "KEITH",
"name_prefix": "Dr.",
"name_suffix": "II",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-14",
"last_updated": "2021-11-17",
"certification_date": "2021-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "UT",
"license": "11488542-9923",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bountiful, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.