NPIMap

Organization Active NPI

Dr. Doug's Pediatric Dentistry P.C.

  • Pediatric Dentistry
  • Logan, UT
National Provider Identifier
1780004267
Registry record updated Apr 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
285140-9923 Issued in UT
Legal business name
DR. DOUG'S PEDIATRIC DENTISTRY P.C.
Practice address
1300 N 200 E
Suite102
Logan, UT 84341-2398
Phone
(435) 232-9721
Fax
(435) 792-3033
NPI assigned
Apr 23, 2014
Last updated
Apr 23, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2014

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

Authorized official

Name
Dr. Kenneth Douglas Fryer, D.D.S., M.SNPI 1174744585
Title
President
Phone
(435) 792-3033

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 285140-9923 UT Primary

Addresses

Primary practice location

1300 N 200 E
Suite102
Logan, UT 84341-2398

Mailing address

1300 N 200 E
Suite102
Logan, UT 84341-2398
Phone (435) 232-9721

Other names 1

  • Small Smiles Pediatric Dentistry P.C. Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Dr Doug's Pediatric Dentistry PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1300 N 200 E
Ste 102
Logan, UT 84341
Phone (435) 232-9721

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1398211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398211200000",
    "number": "1780004267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 N 200 E",
            "address_2": "SUITE102",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412398",
            "telephone_number": "435-232-9721",
            "fax_number": "435-792-3033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N 200 E",
            "address_2": "SUITE102",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412398",
            "telephone_number": "435-232-9721",
            "fax_number": "435-792-3033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. DOUG'S PEDIATRIC DENTISTRY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-23",
        "last_updated": "2014-04-23",
        "status": "A",
        "authorized_official_last_name": "FRYER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "435-792-3033",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.S"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "UT",
            "license": "285140-9923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Small Smiles Pediatric Dentistry P.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Logan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2014; 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.