NPIMap

Organization Active NPI

Brad a. Wahlstrom, D.D.S., P.C.

  • Dentist
  • West Jordan, UT
National Provider Identifier
1831405513
Registry record updated Aug 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
4791609-9923 Issued in UT
Legal business name
BRAD A. WAHLSTROM, D.D.S., P.C.
Practice address
7089 S Redwood Rd
West Jordan, UT 84084-3420
Phone
(801) 566-3003
Fax
(801) 568-1710
NPI assigned
Aug 19, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2010

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

Authorized official

Name
Dr. Brad A. Wahlstrom, D.D.S.NPI 1861572455
Title
President
Phone
(801) 566-3003

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 4791609-9923 UT Primary

Addresses

Primary practice location

7089 S Redwood Rd
West Jordan, UT 84084-3420

Mailing address

7089 S Redwood Rd
West Jordan, UT 84084-3420
Phone (801) 566-3003

National Provider Directory

National Provider Directory

Locations

7089 S Redwood Rd
West Jordan, UT 84084
Phone (801) 566-3003

Practitioners & affiliated clinicians

Practitioners 1

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": "1282176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282176000000",
    "number": "1831405513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7089 S REDWOOD RD",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840843420",
            "telephone_number": "801-566-3003",
            "fax_number": "801-568-1710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7089 S REDWOOD RD",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840843420",
            "telephone_number": "801-566-3003",
            "fax_number": "801-568-1710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAD A. WAHLSTROM, D.D.S., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-19",
        "last_updated": "2010-08-19",
        "status": "A",
        "authorized_official_last_name": "WAHLSTROM",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-566-3003",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "UT",
            "license": "4791609-9923",
            "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 Aug 19, 2010; 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.