SOUTH DAVIS PEDIATRIC DENTISTRY LLC (NPI# 1841891462) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841891462 |
| Entity Type | Organization |
| Organization Name | SOUTH DAVIS PEDIATRIC DENTISTRY LLC |
| Practice Address |
59 W Pages Ln Ste 110 Bountiful UT 84010-5988 |
| Practice Telephone | 8012948880 |
| Enumeration Date | 2020-11-02 |
| Last Update Date | 2020-11-02 |
| Authorized Official Name | CHARLES ODION (OWNER) |
| Authorized Official Telephone | 8012948880 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| Street Address |
59 W PAGES LN STE 110 |
| City | BOUNTIFUL |
| State | UT |
| Zip Code | 84010-5988 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225699192 | Jessyca K Willie | Behavior Technician | 415 S. Medical Drive Suite D101, Bountiful, UT 84010 | 2019-06-21 |
| 1336634344 | Shanna Joy Jaggers | Social Worker | 2333 S 200 E, Bountiful, UT 84010 | 2018-06-22 |
| 1447773171 | Live Life Alarms | Emergency Response System Companies | 640 South 500 West, Bountiful, UT 84010 | 2017-07-25 |
| 1902328842 | Hailey Embley | Behavior Technician | 415 Medical Drive D 101, Bountiful, UT 84010 | 2017-07-12 |
| 1508318031 | Beverly Nielsen | Psychologist | 1001 Lakeview Drive, Bountiful, UT 84010 | 2016-11-01 |
| 1295287720 | Samantha Oslund | Speech-Language Pathologist | 415 Medical Dr Ste B102, Bountiful, UT 84010 | 2016-11-01 |
| 1750748273 | Jeremy Clark Morris | Dentist | 59 W 1600 N, Suite 110, Bountiful, UT 84010 | 2016-01-28 |
| 1629464706 | Shane James | Speech-Language Pathologist | 425 Medical Dr Ste 122, Bountiful, UT 84010 | 2015-04-15 |
| 1891186102 | Kenton Francis | Social Worker | 1355 North Main Street #1, Bountiful, UT 84010 | 2015-02-09 |
| 1205233855 | Modern Dental Professionals - Utah, PC | Dentist | 24 S. 500 West, #a, Bountiful, UT 84010 | 2014-11-25 |
| Find all providers in zip 84010 | ||||
| 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 |
|---|---|---|---|---|
| 1750748273 | Jeremy Clark Morris | Dentist | 59 W 1600 N, Suite 110, Bountiful, UT 84010 | 2016-01-28 |
| 1598885659 | Colleen P Taylor | Dentist | 535 E Medical Drive, Bountiful, UT 84010 | 2007-03-30 |
| 1770001612 | Creek Capital Orchard Drive LLC | Dentist | 3377 Orchard Dr, Bountiful, UT 84010-8005 | 2017-08-30 |
| 1235505587 | Children's Dentistry | Dentist | 1551 Renaissance Towne Dr, Ste 540, Bountiful, UT 84010-7667 | 2015-08-20 |
| 1720290802 | Chris Reed Simonsen | Dentist | 535 E 500 S, Bountiful, UT 84010-3873 | 2007-05-03 |
| 1215997663 | Mark L Nelson | Dentist | 1551 Renaissance Towne Dr, Suite 540, Bountiful, UT 84010-7667 | 2006-03-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1952829897 | Creek Capital Oquirrh Park LLC | Dentist | 6973 S 4800 W Ste C, West Jordan, UT 84084-7927 | 2017-08-30 |
| Find all providers with the same taxonomy | ||||
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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.