Brad A Wahlstrom, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4791609 Issued in UT

Practice address

7089 Redwood Rd
West Jordan, UT 84084-3420

Phone

(801) 566-3003

Fax

(801) 568-1710

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brad a. Wahlstrom, D.D.S., P.C.

  • Dentist
  • West Jordan, UT
  • NPI 1831405513
  NPD (past) Authorized official

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1861572455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7089 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 REDWOOD RD",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840843420",
            "telephone_number": "801-566-3003",
            "fax_number": "801-568-1710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHLSTROM",
        "first_name": "BRAD",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "4791609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wade T. Smith, DO
• Katherine Wade
• Chandler Waelty
• Walter W Wagner, D.C.
• Wells Wesley Wagner, D.D.S.
• Richard Lee Wailes, LCSW
• N. John-Evan Waite, M.S.
• Alli Wakley
• Wal-Mart Stores, Inc
• Walgreen Co

• General Practice Dentistry in West Jordan, UT
• Providers in West Jordan, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.