OUT OF THIS WORLD DENTISTRY SJ PC (NPI# 1811396260) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811396260 |
| Entity Type | Organization |
| Organization Name | OUT OF THIS WORLD DENTISTRY SJ PC |
| Other Organization Name | OUT OF THIS WORLD SJ |
| Practice Address |
10426 S. 4000 W. South Jordan UT 84009 |
| Practice Telephone | 8012600400 |
| Practice Fax Number | 8016195399 |
| Mailing Telephone | (801) 260-0400 |
| Mailing Fax Number | 8016195399 |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2017-08-07 |
| Authorized Official Name | CORY STARK (OWNER) |
| Authorized Official Telephone | 8012600400 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | Y |
| Parent Organization Name | OUT OF THIS WORLD DENTISTRY PC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Out of This World SJ | Doing Business As Name - Organization |
| Street Address |
10426 S. 4000 W. |
| City | SOUTH JORDAN |
| State | UT |
| Zip Code | 84009 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104347061 | Pony Express Dental Daybreak, LLC | Clinic/Center | 5396 W Daybreak Parkway, South Jordan, UT 84009 | 2017-06-30 |
| 1831630763 | Tina Patel | Dentist | 11501 S 4000 W Ste 101, South Jordan, UT 84009 | 2017-03-10 |
| 1184970956 | Robert Owyn Lindquist IIi | Social Worker | 10609 S. Granby Way, South Jordan, UT 84009 | 2012-07-31 |
| 1013138254 | Kelly Kristen Adams | Pediatrics | 4686 W Crosswater Road, South Jordon, UT 84009 | 2007-05-02 |
| 1760081061 | Someone To Talk To | Psychologist | 10352 S Sturgeon Dr, South Jordan, UT 84009-1218 | 2020-10-19 |
| 1699317685 | Daybreak Pdc Pllc | Dentist | 4040 West Daybreak Pkwy, Suite 103, South Jordan, UT 84009-1286 | 2019-10-11 |
| 1518414911 | Charli Danielle Peters | Nurse Practitioner | 9636 S Skye Park Rd, South Jordan, UT 84009-1506 | 2016-09-02 |
| 1760933832 | Naomi Mackert | Massage Therapist | 4988 W Wood Ranch Dr, South Jordan, UT 84009-1532 | 2016-10-24 |
| 1396285425 | Preston Howard Catmull | Physical Therapist | 9988 S Hook Dr, South Jordan, UT 84009-2786 | 2017-03-08 |
| 1366079097 | Live Well Counseling Services Pllc | Social Worker | 3654 W 9800 S, South Jordan, UT 84009-3260 | 2020-03-24 |
| Find all providers in zip 84009 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821525288 | Justin Vanbibber Dmd PC | Dentist | 4775 W Daybreak Pkwy Ste 103, South Jordan, UT 84009-5139 | 2017-05-17 |
| 1134536907 | Copper Cove Pediatric Dentistry | Dentist | 3473 W South Jordan Pkwy Ste 3, South Jordan, UT 84095-6016 | 2014-07-14 |
| 1376550111 | David Michael Sine Stewart | Dentist | 1268 W South Jordan Pkwy Ste 101, South Jordan, UT 84095-4653 | 2006-08-02 |
| 1285685594 | David Christian Roth | Dentist | 2651 W 10400 S, Suite 103, South Jordan, UT 84095-8953 | 2006-05-12 |
| 1245720788 | Pony Express Dentalkids, LLC | Dentist | 5396 W Daybreak Pkwy, South Jordan, UT 84009-5900 | 2018-05-10 |
| 1679823058 | Michael R. Cottam Ms Dmd Pllc | Dentist | 4775 W Daybreak Pkwy, South Jordan, UT 84095-5968 | 2012-09-13 |
| 1215213905 | David M. S. Stewart Dds PC | Dentist | 1268 W South Jordan Pkwy, Suite 101, South Jordan, UT 84095-4652 | 2011-10-26 |
| 1073804001 | Thayne Henrie Gardner | Dentist | 1268 W South Jordan Pkwy, Suite 101, South Jordan, UT 84095-4652 | 2011-04-25 |
| 1215987797 | Russell Wirthlin Farnsworth | Dentist | 2651 W 10400 S, Suite 103, South Jordan, UT 84095-8953 | 2006-05-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841891462 | South Davis Pediatric Dentistry LLC | Dentist | 59 W Pages Ln Ste 110, Bountiful, UT 84010-5988 | 2020-11-02 |
| 1376176198 | Happy Tooth Pediatric Dentistry, LLC | Dentist | 2453 E 3300 S, Millcreek, UT 84109-2725 | 2020-02-20 |
| 1750932273 | Michael R. Brown Dds Ms | Dentist | 1240 E 100 S Ste 120, St George, UT 84790-3079 | 2019-09-25 |
| 1609438357 | Children's Landing Pediatric Dentistry, PC | Dentist | 3855 W 7800 S Ste 200, West Jordan, UT 84088-5563 | 2019-07-02 |
| 1841766821 | Dry Creek Pediatric Dentistry | Dentist | 3300 N Running Creek Way F101, Lehi, UT 84043 | 2018-10-17 |
| 1639654684 | Clubhouse Pediatric Dentistry of West Jordan | Dentist | 1108 E South Union Ave, Midvale, UT 84047-2904 | 2018-09-26 |
| 1639667801 | St. George Kids Dental At Snow Canyon | Dentist | 1100 Canyon View Dr Ste A, Santa Clara, UT 84765-5672 | 2018-04-24 |
| 1376044313 | Slpd Cottonwood LLC | Dentist | 7167 South Highland Drive, 200, Cottonwood Heights, UT 84121 | 2018-02-26 |
| 1013420553 | Kevin Brown Dmd, LLC | Dentist | 1030 S 1100 W, Suite B, Lehi, UT 84043 | 2017-11-07 |
| 1518478742 | Lcr Dental Sugar House | Dentist | 2068 S 2100 E Suite #a, Salt Lake City, UT 84108 | 2017-10-16 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH JORDAN |
| Zip Code | 84009 |
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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.