NPIMap

Organization Active NPI

Pediatric Dental PC

  • Pediatric Dentistry
  • Farmington, UT
National Provider Identifier
1992880710
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
341292 Issued in UT
Legal business name
PEDIATRIC DENTAL PC
Practice address
1401 N Highway 89
#200
Farmington, UT 84025-2745
Phone
(801) 447-5437
Fax
(801) 447-4685
NPI assigned
Oct 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. John R. AndersonNPI 1407822000
Title
Owner
Phone
(801) 540-5081

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 341292 UT Primary

Addresses

Primary practice location

1401 N Highway 89
#200
Farmington, UT 84025-2745

Mailing address

1401 N Highway 89
#200
Farmington, UT 84025-2745
Phone (801) 447-5437

Other identifiers 1

IdentifierTypeStateIssuer
528537398004MedicaidUT

National Provider Directory

National Provider Directory

Locations

1401 N Highway 89
Ste 200
Farmington, UT 84025
Phone (801) 447-5437

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992880710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 N HIGHWAY 89",
            "address_2": "#200",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252745",
            "telephone_number": "801-447-5437",
            "fax_number": "801-447-4685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 N HIGHWAY 89",
            "address_2": "#200",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252745",
            "telephone_number": "801-447-5437",
            "fax_number": "801-447-4685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-540-5081",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "UT",
            "license": "341292",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528537398004",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, UT

Sources for this page

  • 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.