Mark Louis Pettit, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2763579922 Issued in UT

Practice address

1060 E 100 S
Suite 302
Salt Lake City, UT 84102-1501

Phone

(801) 328-1633

Fax

(801) 328-4065

NPI assigned

Sep 28, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426723200000",
    "number": "1760574701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1060 E 100 S",
            "address_2": "SUITE 302",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021501",
            "telephone_number": "801-328-1633",
            "fax_number": "801-328-4065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 E 100 S",
            "address_2": "SUITE 302",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021501",
            "telephone_number": "801-328-1633",
            "fax_number": "801-328-4065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIT",
        "first_name": "MARK",
        "middle_name": "LOUIS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2015-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "2763579922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lexi Pettibone
• David Pettigrew
• Warren Woodrich Pettine, MD
• Carson William Pettingill
• Jessica Mignon Pettit
• Brianne Dahl Petty, AMFT
• Dillon Clint Petty, MD
• Lloyd Petty, DO, MPH
• Yuliya Petukhova, MD, DDS
• Margaret Patricia Petzold, MD

• General Practice Dentistry in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2015; 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.