Individual provider Active NPI

Bruce Park Loosli, DMD

  • Dentist
  • West Jordan, UT
National Provider Identifier
1790978682
Registry record updated Jan 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
145173-9922 Issued in UT
Practice address
3823 W 9000 S Ste B
West Jordan, UT 84088-5604
Phone
(018) 679-3455
Fax
(801) 849-8291
NPI assigned
Aug 23, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 145173-9922 UT Primary

Addresses

Primary practice location

3823 W 9000 S Ste B
West Jordan, UT 84088-5604

Mailing address

3823 W 9000 S Ste B
West Jordan, UT 84088-5604
Phone (018) 679-3455

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
145173-9922UTMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Cascade Dental Care Inc CurrentSince Oct 12, 2025 Accepting new patients
TD Operations LLC Past Accepting new patients
Tooth Doctor - WVC PLLC Dentist Past Accepting new patients

Locations

3823 W 9000 S
Ste Ab
West Jordan, UT 84088
Phone (801) 679-3455

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1187827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736121600000",
    "number": "1790978682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3823 W 9000 S STE B",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840885604",
            "telephone_number": "018-679-3455",
            "fax_number": "801-849-8291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3823 W 9000 S STE B",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840885604",
            "telephone_number": "018-679-3455",
            "fax_number": "801-849-8291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOOSLI",
        "first_name": "BRUCE",
        "middle_name": "PARK",
        "name_prefix": "Mr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-23",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "145173-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Jordan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; 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.