Jared G Anderton, DDS
Individual provider Active NPI General Practice Dentistry · Ogden, UT
NPI 1992880074 · NPPES record last updated May 5, 2016
Key facts
- NPI
- 1992880074
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 6242001 (UT)
- Practice address
- 3920 University Cir
Ogden, UT 84408-3920 - Phone
- (801) 626-7169
- Fax
- (801) 394-4609
- NPI assigned
- Oct 26, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160609000335 | UT | Order and Referring Only - Dentist |
1658661368 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6242001 | UT | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6242001 | UT | Yes |
Addresses
Primary practice location
3920 University Cir
Ogden, UT 84408-3920
Mailing address
1860 E Skyline Dr
South Ogden, UT 84403-5217
Phone (801) 621-1835
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 539444090005 | Medicaid | UT |
Other providers in Ogden, UT
- Tyler Aldon Anderson
- Vance Anderson
- Anderton Dental Group
- Brett Anderton
- Eric B Anderton
- Travis Andreasen
- Robert L Andres
- Angels Companionship & Transportation LLC
- Timothy D Annis
- Apex Healthcare
All providers in Ogden, UT · General Practice Dentistry in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.