NPIMap

Organization Active NPI

Pacific West Dental Group

  • Pediatric Dentistry
  • Syracuse, UT
National Provider Identifier
1811269756
Registry record updated Jan 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
4921068 Issued in UT
Legal business name
PACIFIC WEST DENTAL GROUP
Practice address
1792 W 1700 S Ste 101
Syracuse, UT 84075-9650
Phone
(801) 614-0099
Fax
(801) 776-3661
NPI assigned
Feb 8, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2016

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

Authorized official

Name
Mrs. Cathilyn Self
Title
Insurance Coordinator
Phone
(801) 614-0099

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 4921068 UT Primary

Addresses

Primary practice location

1792 W 1700 S Ste 101
Syracuse, UT 84075-9650

Mailing address

1792 W 1700 S Ste 101
Syracuse, UT 84075-9650
Phone (801) 614-0099

Other names 1

  • Atlantis Pediatric Dentistry Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1328659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451865600000",
    "number": "1811269756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1792 W 1700 S STE 101",
            "city": "SYRACUSE",
            "state": "UT",
            "postal_code": "840759650",
            "telephone_number": "801-614-0099",
            "fax_number": "801-776-3661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1792 W 1700 S STE 101",
            "city": "SYRACUSE",
            "state": "UT",
            "postal_code": "840759650",
            "telephone_number": "801-614-0099",
            "fax_number": "801-776-3661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC WEST DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-08",
        "last_updated": "2016-01-04",
        "status": "A",
        "authorized_official_last_name": "SELF",
        "authorized_official_first_name": "CATHILYN",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "801-614-0099",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "UT",
            "license": "4921068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Atlantis Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Syracuse, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2016; 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.