Vine Street Pediatric Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

VINE STREET PEDIATRIC DENTISTRY

Practice address

678 E Vine St
Suite #12
Murray, UT 84107-5546

Phone

(801) 268-1135

Fax

(801) 685-7630

NPI assigned

Jun 27, 2007

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

Office Manager

Phone

(801) 268-1135

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962609644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "678 E VINE ST",
            "address_2": "SUITE #12",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841075546",
            "telephone_number": "801-268-1135",
            "fax_number": "801-685-7630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "678 E VINE ST",
            "address_2": "SUITE #12",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841075546",
            "telephone_number": "801-268-1135",
            "fax_number": "801-685-7630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINE STREET PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NICOL",
        "authorized_official_first_name": "MARCI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "801-268-1135"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alejandra Villagomez
• Yaritza Villagomez
• Elsa Villegas
• Kempton Vincent
• Vine Street Pediatric Dentistry
• Caroline G Vines, M.D.
• Vision Health Center, Inc.
• Visionworks Inc
• Patricia A Vitale, MD
• Tamara Lin Vitela, L.C.S.W.

• Pediatric Dentistry in Murray, UT
• Providers in Murray, UT by specialty
• Pediatric 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.