NPIMap

Organization Active NPI

Southtown Endodontics

  • Endodontics
  • Sandy, UT
National Provider Identifier
1780694885
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
55467 Issued in UT
Legal business name
SOUTHTOWN ENDODONTICS
Practice address
45 W 10000 S
Suite 305
Sandy, UT 84070
Phone
(801) 233-0503
Fax
(801) 233-0593
NPI assigned
Aug 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Thomas Mark Van Den Berghe, DDSNPI 1770506610
Title
Owner
Phone
(801) 233-0503

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223E0200X 55467 UT Primary

Addresses

Primary practice location

45 W 10000 S
Suite 305
Sandy, UT 84070

Mailing address

45 W 10000 S
Suite 305
Sandy, UT 84070
Phone (801) 233-0503

National Provider Directory

National Provider Directory

Locations

45 W Sego Lily Dr
Ste 305
Sandy, UT 84070
Phone (801) 233-0503

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780694885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 W 10000 S",
            "address_2": "SUITE 305",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "84070",
            "telephone_number": "801-233-0503",
            "fax_number": "801-233-0593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 W 10000 S",
            "address_2": "SUITE 305",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "84070",
            "telephone_number": "801-233-0503",
            "fax_number": "801-233-0593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHTOWN ENDODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VAN DEN BERGHE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-233-0503",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "UT",
            "license": "55467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandy, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.