BONNEVILLE PREVENTIVE DENTISTRY PLLC (NPI# 1255776431) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255776431 |
| Entity Type | Organization |
| Organization Name | BONNEVILLE PREVENTIVE DENTISTRY PLLC |
| Practice Address |
3860 Jackson Ave Suite 6 Ogden UT 84403-1956 |
| Practice Telephone | 8016270420 |
| Mailing Telephone | 8016270420 |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2013-05-01 |
| Authorized Official Name | MATTHEW WOLPERT (DIRECTOR) |
| Authorized Official Telephone | 8016270420 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
8289908 | UT | Ambulatory Health Care Facilities |
| Street Address |
3860 JACKSON AVE SUITE 6 |
| City | OGDEN |
| State | UT |
| Zip Code | 84403-1956 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487672986 | David More Allen | Specialist | 3860 Jackson Ave, Ste 2, Ogden, UT 84403-1997 | 2006-07-17 |
| 1457894149 | Malan Dental PC | Dentist | 3860 Jackson Ave, Ste 5, Ogden, UT 84403-1956 | 2016-11-29 |
| 1730416066 | Katherine Helen Mader | Physician Assistant | 3860 Jackson Ave, Suite 2, Ogden, UT 84403-1956 | 2009-11-06 |
| 1952443772 | E Judd West Dds | Dentist | 3860 Jackson Ave, Suite 6, Ogden, UT 84403-1956 | 2007-02-12 |
| 1679613673 | E Judd West Jr. | Dentist | 3860 Jackson Ave, Suite 6, Ogden, UT 84403-1956 | 2007-02-07 |
| 1225124225 | Matthew Wendall Malan | Dentist | 3860 Jackson Ave, Suite 4, Ogden, UT 84403-1956 | 2006-10-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235744632 | Megan Louise Larkins | Specialist/Technologist | 4000 Brinker Ave. The Apartments., Apartment 15, Ogden, UT 84403 | 2020-09-11 |
| 1154959062 | Joshua Clifford Hansen | Student in an Organized Health Care Education/Training Program | 4403 Harrison Boulevard, Ste A700, Ogden, UT 84403 | 2020-03-28 |
| 1346895935 | Positional Release Therapy Institute LLC | Specialist/Technologist | 1702 E. 5600 S., Ogden, UT 84403 | 2019-08-09 |
| 1841842077 | Braken Wooden | Chiropractor | 1893 Skyline Dr., Suite 204, South Ogden, UT 84403 | 2019-07-09 |
| 1023670569 | Wasatch Advanced Dental Care LLC | Dentist | 3590 Harrison Blvd Suite #1, Ogden, UT 84403 | 2019-07-05 |
| 1194237636 | Marci Niemeyer | Physician Assistant | 5929 Fashion Point Dr Ste 101, South Ogden, UT 84403 | 2017-10-24 |
| 1578081949 | Stephanie Jensen | Specialist/Technologist | 1473 36th Street, Ogden, UT 84403 | 2017-09-06 |
| 1891213385 | Forrest Sutherland | Specialist/Technologist | 1075 E 41st St., Ogden, UT 84403 | 2017-09-05 |
| 1184159022 | Nicole Lee Van Tassell | In Home Supportive Care | 1496 East 5600 South, Unit 6, Ogden, UT 84403 | 2017-04-28 |
| 1265889166 | Modern Dental Professionals Ut, PC | Dentist | 5974 S. Fashion Pointe Drive, Suite 210, South Ogden, UT 84403 | 2016-05-20 |
| Find all providers in zip 84403 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104041565 | Patricia Smyth D.d.s.,l.c. | Clinic/Center | 5300 S. Adams Ave. Pkwy., Suite 1, Ogden, UT 84405-6955 | 2007-04-13 |
| 1003462292 | Eric G Russell Dds LLC | Clinic/Center | 5685 S 1475 E Ste 4a, Ogden, UT 84403-4598 | 2019-08-13 |
| 1386207835 | Ihc Health Services Inc | Clinic/Center | 4403 Harrison Blvd Ste 3875, Ogden, UT 84403-3332 | 2019-04-19 |
| 1992275945 | Pleasant Valley Cosmetic & Laser Dental Pllc | Clinic/Center | 5742 Adams Ave Pkwy, Ogden, UT 84405-7157 | 2018-12-03 |
| 1073010955 | Rocky Mountain Dental & Surgical Center | Clinic/Center | 2703 N 1600 W, Ogden, UT 84404 | 2018-04-09 |
| 1407243579 | Michael A Blamires Dds, Inc | Clinic/Center | 1770 Combe Rd Ste 3, Ogden, UT 84403-5067 | 2015-04-16 |
| 1851712467 | Starley Family Dental, LLC | Clinic/Center | 3590 Harrison Blvd Ste 6, Ogden, UT 84403-2012 | 2013-12-27 |
| 1639479488 | Wasatch Dental Association, P.C. | Clinic/Center | 1245 Capitol St, Suite 106-s, Ogden, UT 84401-2847 | 2010-10-27 |
| 1447442496 | Midtown Community Health Center Inc | Clinic/Center | 2240 Adams Ave, Ogden, UT 84401-1511 | 2007-08-14 |
| 1235341744 | Lloyd V. Tilt, Dds,ms,pc | Clinic/Center | 3590 Harrison Blvd, Ste 3, Ogden, UT 84403-2403 | 2007-05-04 |
| Find all providers in OGDEN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.