Bryan E Gottfredson DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

360010-9922 Issued in UT

Legal business name

BRYAN E GOTTFREDSON DDS

Practice address

9010 W 2700 S
Magna, UT 84044-1002

Phone

(801) 250-7311

Fax

(801) 250-3801

NPI assigned

Jul 12, 2010

Last updated

Jul 12, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Bryan Elden Gottfredson, DDSNPI 1174501688

Title

Dentist/ Owner

Phone

(801) 250-7311

Specialties & licenses 1

Addresses

Other names 1

• Main Street Dental of Magna Other name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bryan E Gottfredson, DDS

  • General Practice Dentistry
  • Magna, UT
  • NPI 1174501688
  NPD (past) Authorized official

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

{
    "created_epoch": "1278892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278892800000",
    "number": "1902118557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9010 W 2700 S",
            "city": "MAGNA",
            "state": "UT",
            "postal_code": "840441002",
            "telephone_number": "801-250-7311",
            "fax_number": "801-250-3801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9010 W 2700 S",
            "city": "MAGNA",
            "state": "UT",
            "postal_code": "840441002",
            "telephone_number": "801-250-7311",
            "fax_number": "801-250-3801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRYAN E GOTTFREDSON DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-12",
        "last_updated": "2010-07-12",
        "status": "A",
        "authorized_official_last_name": "GOTTFREDSON",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "ELDEN",
        "authorized_official_title_or_position": "DENTIST/ OWNER",
        "authorized_official_telephone_number": "801-250-7311",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "360010-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Dental of Magna",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Bingham Dental & Orthodontics
• Tab Bingham, DDS
• Michael Ted Boman, LCSW
• Elizabeth Bernadette Borys, FNP-BC
• Taylor Lindsay Brooker
• Ashley Christine Burkett, LCMHC
• Katharine L Caldwell, M.D., M.P.H.
• Nicholas Scott Cantwell, D.D.S.
• Michael Jude Capobianchi Jr., PT, DPT
• Marie Carmichael, FNP-C

• General Practice Dentistry in Magna, UT
• Providers in Magna, 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 12, 2010; 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.