Creek Dental Group Meadowbrook LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

CREEK DENTAL GROUP MEADOWBROOK LLC

Practice address

1148 E Ut-193
Layton, UT 84040

Phone

(801) 383-0147

NPI assigned

Sep 8, 2020

Organization subpart

No

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

Authorized official

Name

Marci Nicol

Title

VP

Phone

(801) 312-1722

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1599523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599523200000",
    "number": "1902410947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 E FORT UNION BLVD STE 100",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840471890",
            "telephone_number": "801-918-4135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1148 E UT-193",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "84040",
            "telephone_number": "801-383-0147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEK DENTAL GROUP MEADOWBROOK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-08",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-02",
        "status": "A",
        "authorized_official_last_name": "NICOL",
        "authorized_official_first_name": "MARCI",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "801-312-1722"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Layton, UT
• Providers in Layton, UT by specialty
• Dentist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; 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.