BOUNTIFUL RIDGE DENTAL, LLC (NPI# 1508387564) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508387564 |
| Entity Type | Organization |
| Organization Name | BOUNTIFUL RIDGE DENTAL, LLC |
| Practice Address |
415 Medical Dr Ste A200 Bountiful UT 84010-4970 |
| Practice Telephone | (801) 203-0290 |
| Practice Fax Number | 8018724329 |
| Mailing Telephone | 8012030290 |
| Mailing Fax Number | 8018724329 |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2017-06-29 |
| Authorized Official Name | DR. MARK SPENCER MCGOWAN (OWNER) |
| Authorized Official Telephone | 8012030290 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
8008797 | UT | Dental Providers |
| Street Address |
415 MEDICAL DR STE A200 |
| City | BOUNTIFUL |
| State | UT |
| Zip Code | 84010-4970 |
| 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 | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154737781 | Mercedes Hanks | Dentist | 25 S 500 W, Ste D, Bountiful, UT 84010-8726 | 2014-07-03 |
| 1861803744 | Stubbs Dental | Dentist | 3383 Orchard Dr, Bountiful, UT 84010-8005 | 2014-05-14 |
| 1558684472 | Hyrum M Cannon | Dentist | 55 E 2200 S, Bountiful, UT 84010-5619 | 2010-03-05 |
| 1396071171 | Brandon Richard Bohn | Dentist | 469 Medical Dr Ste 200, Bountiful, UT 84010-8922 | 2009-10-28 |
| 1831350289 | Andrew Micah Vernon | Dentist | 366 E 2200 S, Bountiful, UT 84010-5626 | 2008-06-18 |
| 1780885947 | James Russon | Dentist | 817 N 250 W, Danbury Lane, Bountiful, UT 84010-6873 | 2007-05-29 |
| 1184742264 | Paul Christian Larsen | Dentist | 395 E 500 S, Bountiful, UT 84010-4924 | 2007-03-27 |
| 1447384268 | Craig J. Mattinson | Dentist | 1355 N Main St Ste 9, Bountiful, UT 84010-5982 | 2007-03-15 |
| 1295871721 | Robert F Page | Dentist | 535 E 500 S Ste C, Bountiful, UT 84010-3873 | 2007-01-30 |
| 1407925225 | Dale Ray Linton | Dentist | 469 Medical Dr, Suite 200, Bountiful, UT 84010-4900 | 2006-11-07 |
| Find all providers in BOUNTIFUL | ||||
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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.