SALT LAKE IMPLANTS AND PERIODONTICS (NPI# 1922664556) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922664556 |
| Entity Type | Organization |
| Organization Name | SALT LAKE IMPLANTS AND PERIODONTICS |
| Practice Address |
4010 S 700 E Ste 8 Salt Lake City UT 84107-2582 |
| Practice Telephone | 8012663519 |
| Mailing Telephone | 8012663519 |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2019-05-20 |
| Authorized Official Name | MARK MANGELSON (OWNER) |
| Authorized Official Telephone | 8012663519 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers |
| Street Address |
4010 S 700 E STE 8 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84107-2582 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851439251 | Mark Legrand Mangelson | Dentist | 4010 S 700 E Ste 8, Salt Lake City, UT 84107-2573 | 2007-02-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902410517 | Brielle Nicole Poulter | Student in an Organized Health Care Education/Training Program | 345 East 4500 So #260, Murray, UT 84107 | 2020-09-01 |
| 1467016592 | Ashlee Brown | Social Worker | C-134, 5284 Commerce Drive, Murray, Murray, UT 84107 | 2019-04-24 |
| 1568940633 | Samantha Duff | Occupational Therapist | 5770 S Fashion Blvd, Bldg 5 Ste 201, Murray, UT 84107 | 2018-08-01 |
| 1881185247 | Derek John Sharp | Occupational Therapist | 5770 S Fashion Blvd, Bldg #5, Suite 210, Murray, UT 84107 | 2018-05-22 |
| 1093223091 | Erin Nicole Hill | Counselor | 345 East 4500 South Suite 260, Murray, UT 84107 | 2018-01-12 |
| 1588171219 | Nicole Danielle Jensen | Counselor | 345 East 4500 South, Suite 260, Murray, UT 84107 | 2018-01-03 |
| 1043725799 | Greater Endodontics LLC | Dentist | 5334 South Woodrow Street, Suite 201, Salt Lake City, UT 84107 | 2017-12-04 |
| 1043739667 | Karyn K Hodge | Audiologist | 4500 So. 777. E. Ste #110, Murray, UT 84107 | 2017-09-14 |
| 1912426750 | Brandon C Burton | Specialist/Technologist, Other | Cta Community Supports 4444 S, 700 E Suite 203, Salt Lake City, UT 84107 | 2017-09-13 |
| 1396261152 | Megan Lehane Delano | Plastic Surgery | 5169 Cottonwood St Ste 420, Murray, UT 84107 | 2017-08-14 |
| Find all providers in zip 84107 | ||||
| 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 |
| 1558487827 | Redwood Periodontics, LLC | Dentist | 6287 S Redwood Rd Ste 102, Salt Lake City, UT 84123-6653 | 2007-03-21 |
| 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 |
| 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 | 84107 |
Please comment or provide details below to improve the information on SALT LAKE IMPLANTS AND PERIODONTICS.
| 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.