NPIMap

Organization Active NPI

Pro Smiles Utah LLC

  • Dentist
  • South Jordan, UT
National Provider Identifier
1821621129
Registry record updated Feb 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
PRO SMILES UTAH LLC
Practice address
10597 S Beach Comber Way
South Jordan, UT 84009-6132
Phone
(801) 413-2814
NPI assigned
Feb 15, 2020
Last updated
Feb 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2020

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

Authorized official

Name
Dr. Tanner M Clark, DMDNPI 1679841811
Title
Owner/Dentist
Phone
(801) 413-2814

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
Dentist 122300000X NU Primary

Addresses

Primary practice location

10597 S Beach Comber Way
South Jordan, UT 84009-6132

Mailing address

10597 S Beach Comber Way
South Jordan, UT 84009-6132
Phone (208) 317-8555

National Provider Directory

National Provider Directory

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": "1581724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581724800000",
    "number": "1821621129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10597 S BEACH COMBER WAY",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840096132",
            "telephone_number": "208-317-8555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10597 S BEACH COMBER WAY",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840096132",
            "telephone_number": "801-413-2814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO SMILES UTAH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-15",
        "last_updated": "2020-02-15",
        "certification_date": "2020-02-15",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "TANNER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "801-413-2814",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Jordan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.