Active NPI
Jay Glen Shields, DDS
- Dentist
- Bountiful, UT
National Provider Identifier
1902004450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1300729922
- Practice address
- 1037 East Claremont Dr
Bountiful, UT 84010 - Phone
- (801) 295-1613
- Fax
- (801) 295-1613
- NPI assigned
- Jul 6, 2007
- Sex
- Male
- Sole proprietor
- No
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 | 1300729922 | UT | Primary |
Addresses
Primary practice location
1037 East Claremont Dr
Bountiful, UT 84010
Mailing address
1037 E Claremont Dr
Bountiful, UT 84010
Phone (801) 295-1613
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 |
|---|---|---|---|
| 1300729922 | UT | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902004450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1037 E CLAREMONT DR",
"city": "BOUNTIFUL",
"state": "UT",
"postal_code": "84010",
"telephone_number": "801-295-1613",
"fax_number": "801-295-1613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1037 EAST CLAREMONT DR",
"city": "BOUNTIFUL",
"state": "UT",
"postal_code": "84010",
"telephone_number": "801-295-1613",
"fax_number": "801-295-1613"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIELDS",
"first_name": "JAY",
"middle_name": "GLEN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "UT",
"license": "1300729922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bountiful, UT
Sources for this page
- 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.