Over the Road Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

143681-9922 Issued in UT

Legal business name

OVER THE ROAD DENTAL

Practice address

1953 W. California Ave
Salt Lake City, UT 84104

Phone

(801) 886-9341

Fax

(801) 886-1786

NPI assigned

Aug 23, 2006

Organization subpart

No

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

Authorized official

Name

Angie Breeze

Title

Office Manager

Phone

(801) 886-9341

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Michel B. Haynie Other name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bret J Tucker, DDS

  • General Practice Dentistry
  • Salt Lake City, UT
  • NPI 1962671495
  NPD (past)

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912014234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 271069",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841271069",
            "telephone_number": "801-886-9341",
            "fax_number": "801-886-1786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1953 W. CALIFORNIA AVE",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84104",
            "telephone_number": "801-886-9341",
            "fax_number": "801-886-1786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OVER THE ROAD DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BREEZE",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "801-886-9341"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "143681-9922",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "545764459023",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Michel B. Haynie",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Trinh Nguyen Outtrim, MD
• Wei Lin Ouyang, MD
• Yarelly Lizbeth Ovalle Rodriguez
• Miguel Ovalle
• Kelly J Ovard
• Rebecca Overbury, M.D
• Overlake Terrace Assisted Living
• Jessica M Overson
• Amber Mecham Overton, PHARMD
• Melissa Oveson

• General Practice Dentistry in Salt Lake City, UT
• Providers in Salt Lake 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 Aug 22, 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.