Andrew B Theurer, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8718432-9922 Issued in UT

Practice address

12465 S Fort St
Suite 100
Draper, UT 84020-9021

Phone

(801) 576-1167

NPI assigned

Jun 26, 2013

Last updated

Jun 26, 2013By the provider in NPPES

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: Yes
• Power mobility devices: No
• Hospice: Yes

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• 12465 S Fort St Draper Dental LLC

  dba Corner Canyon Family Dental

  • Dental Clinic/Center
  • Draper, UT
  • NPI 1790593051
  NPD (past)

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

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372204800000",
    "number": "1881034551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12465 S FORT ST",
            "address_2": "SUITE 100",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840209021",
            "telephone_number": "801-576-1167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12465 S FORT ST",
            "address_2": "SUITE 100",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840209021",
            "telephone_number": "801-576-1167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEURER",
        "first_name": "ANDREW",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-26",
        "last_updated": "2013-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "8718432-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• The West Clinic Draper
• Michelle Thomas, CCC-SLP
• Rylin Thomas
• Sydney Thomas
• Tracy Elle Thomas, LCSW
• Warren Thomason

• General Practice Dentistry in Draper, UT
• Providers in Draper, 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 Jun 26, 2013; 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.