Salt Lake Implants and Periodontics

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

SALT LAKE IMPLANTS AND PERIODONTICS

Practice address

4010 S 700 E Ste 8
Salt Lake City, UT 84107-2582

Phone

(801) 266-3519

NPI assigned

May 20, 2019

Organization subpart

No

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

Authorized official

Name

Mark Mangelson, DDSNPI 1851439251

Title

Owner

Phone

(801) 266-3519

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Mark Legrand Mangelson, DDS, MS

  • Periodontics
  • Salt Lake City, UT
  • NPI 1851439251
  NPD (past) Authorized official

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

{
    "created_epoch": "1558310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558310400000",
    "number": "1922664556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4010 S 700 E STE 8",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841072582",
            "telephone_number": "801-266-3519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4010 S 700 E STE 8",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841072582",
            "telephone_number": "801-266-3519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALT LAKE IMPLANTS AND PERIODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-20",
        "last_updated": "2019-05-20",
        "status": "A",
        "authorized_official_last_name": "MANGELSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-266-3519",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Periodontics in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2019; 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.