NPIMap

Organization Active NPI

Kids Creek Ped. Dentistry

  • Pediatric Dentistry
  • Taylorsville, UT
National Provider Identifier
1821521485
Registry record updated Apr 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
7693653 Issued in UT
Legal business name
KIDS CREEK PED. DENTISTRY
Practice address
2964 W 4700 S Ste 103
Taylorsville, UT 84129-2558
Phone
(801) 417-8080
NPI assigned
Apr 10, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2017

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

Authorized official

Name
Samuel B Bailey
Title
Owner
Phone
(801) 417-8080

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 7693653 UT Primary

Addresses

Primary practice location

2964 W 4700 S Ste 103
Taylorsville, UT 84129-2558

Mailing address

2964 W 4700 S Ste 103
Taylorsville, UT 84129-2558
Phone (801) 417-8080

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1491782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491782400000",
    "number": "1821521485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2964 W 4700 S STE 103",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841292558",
            "telephone_number": "801-417-8080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2964 W 4700 S STE 103",
            "city": "TAYLORSVILLE",
            "state": "UT",
            "postal_code": "841292558",
            "telephone_number": "801-417-8080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS CREEK PED. DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-10",
        "last_updated": "2017-04-10",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-417-8080"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "UT",
            "license": "7693653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Taylorsville, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2017; 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.