Paul G. Innis, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

144608-9922 Issued in UT

Practice address

1901 Prospector Ave
Park City, UT 84060-7207

Phone

(435) 649-6332

Fax

(435) 649-3144

NPI assigned

May 15, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Paul Innis DMD Inc

  • General Practice Dentistry
  • Park City, UT
  • NPI 1164624110
  NPD (past) Authorized official

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1871709790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 681179",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840681179",
            "telephone_number": "435-649-6332",
            "fax_number": "435-649-3144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 PROSPECTOR AVE",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840607207",
            "telephone_number": "435-649-6332",
            "fax_number": "435-649-3144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INNIS",
        "first_name": "PAUL",
        "middle_name": "G.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "144608-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ihc Health Services, Inc. (Kimball Junction Pediatrics Clinic)
• Ihc Health Services, Inc. (Park City Surgical Center)
• Ihc Health Services, Inc. (Lifestyle Medicine Wellness Center - Park City)
• Ihc Health Services, Inc. (Intermountain Concierge Health)
• Infinite Horizons Counseling PLLC
• Insight Psychotherapy LLC
• Integral Behavioral Health Services, LLC
• Iron Horse PT
• Nina Ivanova
• Katherine Ivers, ATC

• General Practice Dentistry in Park City, UT
• Providers in Park City, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.