REDWOOD PERIODONTICS, LLC (NPI# 1558487827) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558487827 |
| Entity Type | Organization |
| Organization Name | REDWOOD PERIODONTICS, LLC |
| Practice Address |
6287 S Redwood Rd Ste 102 Salt Lake City UT 84123-6653 |
| Practice Telephone | 8012938833 |
| Practice Fax Number | 8012938844 |
| Mailing Telephone | 8012938833 |
| Mailing Fax Number | 8012938844 |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2008-07-23 |
| Authorized Official Name | DR. JEREMY DWIGHT MANWARING (OWNER) |
| Authorized Official Telephone | 8012938833 |
| Authorized Official Credential | DMD, MS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
56827969922 | UT | Dental Providers |
| Street Address |
6287 S REDWOOD RD STE 102 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84123-6653 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255585725 | Sean Briant Mckeown | Dentist | 6287 S Redwood Rd Ste 102, Salt Lake City, UT 84123-6653 | 2008-11-11 |
| 1942465513 | Erik Taylor Badger | Dentist | 6287 S Redwood Rd Ste 102, Salt Lake City, UT 84123-6653 | 2008-07-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679186837 | Utah Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 5792 South Redwood Road, Taylorsville, UT 84123 | 2020-08-27 |
| 1164040614 | Mark E Hutchinson | Counselor | 5047 S Galleria Drive, Murray, UT 84123 | 2020-07-10 |
| 1396259321 | Utah Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 4082 South Redwood Road, West Valley Road, UT 84123 | 2017-11-29 |
| 1083131890 | Kelli Mcstotts | Counselor | 5689 S. Redwood Road, Taylorsville, UT 84123 | 2017-08-23 |
| 1740706571 | Laura B Ellsworth | Case Manager/Care Coordinator | 5667 So. Redwood Road, 6b, Salt Lake City, UT 84123 | 2017-08-14 |
| 1790214120 | Integrated Autism Therapies | Behavioral Analyst | 5984 S. Susquehanna, Murray, UT 84123 | 2017-06-08 |
| 1083163885 | Michael John Flint | Counselor | 5861 South Redwood Road, #24, Taylorsville, UT 84123 | 2016-09-22 |
| 1548716236 | Andres Ramos | Licensed Psychiatric Technician | 697 West 4170 South, Murray, UT 84123 | 2016-09-01 |
| 1467807040 | Sheryl R Schindler | Counselor | 5770 South 1550 West, Bldg G, Primary Children's Counseling Center, Taylorsville, UT 84123 | 2016-05-02 |
| 1730562141 | Megan Merica Snarr | Dentist | 597 West 5300 South, Murray, UT 84123 | 2015-07-02 |
| Find all providers in zip 84123 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881982585 | Lloyd V Tilt | Dentist | 1316 Harvard Ave, Salt Lake City, UT 84105-1916 | 2011-07-14 |
| 1780840884 | Larisse Skene | Dentist | 1955 S 13th E, Suite 3, Salt Lake City, UT 84105-3638 | 2008-07-29 |
| 1659536225 | Jeremy Dwight Manwaring | Dentist | 6287 S. Redwood Road, Suite#102, Salt Lake City, UT 84123 | 2008-07-23 |
| 1962615948 | Daniel Heiner Thunell | Dentist | 4252 South Highland Dr., Salt Lake City, UT 84124 | 2007-05-07 |
| 1851439251 | Mark Legrand Mangelson | Dentist | 4010 S 700 E Ste 8, Salt Lake City, UT 84107-2573 | 2007-02-01 |
| 1750432449 | Jon D Manwaring | Dentist | 7138 So Highland Dr, #109, Salt Lake City, UT 84121 | 2007-01-16 |
| 1114014784 | Christian Andre Nielsen | Dentist | 1955 S 1300 E Ste 3, Salt Lake City, UT 84105-3683 | 2006-10-06 |
| 1922664556 | Salt Lake Implants and Periodontics | Dentist | 4010 S 700 E Ste 8, Salt Lake City, UT 84107-2582 | 2019-05-20 |
| 1073059267 | Kenneth Gene Bills | Dentist | 2180 E 4500 S, Suite 240, Salt Lake City, UT 84117 | 2017-01-11 |
| 1376893370 | Kenneth G. Bills D.d.s. P.C. | Dentist | 2180 E 4500 S, Suite 240, Salt Lake City, UT 84117-4434 | 2012-09-17 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84123 |
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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.