Active NPI
Tina Patel
- Dentist
- South Jordan, UT
National Provider Identifier
1831630763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10635042-9921
- Practice address
- 11501 S 4000 W Ste 101
South Jordan, UT 84009 - Phone
- (017) 012-1208
- NPI assigned
- Mar 10, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 10635042-9921 | UT | Primary |
Addresses
Primary practice location
11501 S 4000 W Ste 101
South Jordan, UT 84009
Mailing address
1821 W Capitol Ave
West Sacramento, CA 95691-2521
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10635042-9921 | UT | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531785600000",
"number": "1831630763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1821 W CAPITOL AVE",
"city": "WEST SACRAMENTO",
"state": "CA",
"postal_code": "956912521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11501 S 4000 W STE 101",
"city": "SOUTH JORDAN",
"state": "UT",
"postal_code": "84009",
"telephone_number": "017-012-1208"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATEL",
"first_name": "TINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-10",
"last_updated": "2018-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "UT",
"license": "10635042-9921",
"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 Jul 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.