SALT LAKE ENDODONTICS (NPI# 1568612133) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568612133 |
| Entity Type | Organization |
| Organization Name | SALT LAKE ENDODONTICS |
| Practice Address |
1955 S 1300 E Ste 6 Salt Lake City UT 84105-3684 |
| Practice Telephone | 8014870758 |
| Practice Fax Number | 8014870750 |
| Mailing Telephone | 8014870758 |
| Mailing Fax Number | 8014870750 |
| Enumeration Date | 2008-09-19 |
| Last Update Date | 2008-09-19 |
| Authorized Official Name | DR. MITCHELL G RUDD (PRESIDIENT) |
| Authorized Official Telephone | 8014870758 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223E0200X |
Dentist Specialization: Endodontics |
5328713-9922 | UT | Dental Providers |
| Street Address |
1955 S 1300 E STE 6 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84105-3684 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124111323 | Mitchell G Rudd | Dentist | 1955 S 1300 E Ste 6, Salt Lake City, UT 84105-3684 | 2006-10-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285106237 | Laiyan H Bawadeen | Counselor | 1425 700 E Suite #102, Salt Lake City, UT 84105 | 2018-12-31 |
| 1639644255 | Claire Elizabeth Gray | Marriage & Family Therapist | 1425 700 East, Salt Lake City, UT 84105 | 2018-10-10 |
| 1083089643 | Celisa Packer | Social Worker | 2020 E Lake St, Salt Lake City, UT 84105 | 2015-12-08 |
| 1083052963 | Christina Elizabeth Burton | Nurse Practitioner | 1008 S 1100 E, Apt 6, Salt Lake City, UT 84105 | 2013-06-12 |
| 1649548355 | Leland Burt Cowan | Surgery | 1405 Princeton Ave, Salt Lake City, UT 84105 | 2011-12-08 |
| 1639460355 | Sally Cathleen Webster | Counselor | 1248 Yale Avenue, Salt Lake City, UT 84105 | 2011-04-28 |
| 1912205105 | Melissa Wilson | Case Manager/Care Coordinator | 1522 S 1100 E, Salt Lake City, UT 84105 | 2011-03-11 |
| 1013215789 | Tamara Marie Wright | Counselor | 1996 Lake St, Salt Lake City, UT 84105 | 2011-03-04 |
| 1144527243 | Crystal Nicole Garduno | Counselor | 1522 South 1100 East, Salt Lake City, UT 84105 | 2011-02-25 |
| 1508011180 | Keith Elliott | Anesthesiology | 1552 South 1000 East, Salt Lake City, UT 84105 | 2008-11-24 |
| Find all providers in zip 84105 | ||||
| Taxonomy Code | 1223E0200X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Endodontics |
| The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043725799 | Greater Endodontics LLC | Dentist | 5334 South Woodrow Street, Suite 201, Salt Lake City, UT 84107 | 2017-12-04 |
| 1861637308 | Endodontic Associates | Dentist | 1434 E 4500 S Ste 201, Salt Lake City, UT 84117-4252 | 2008-12-12 |
| 1598806648 | Craig C Smith | Dentist | 5373 S Green St, 4th Floor, Salt Lake City, UT 84123-4680 | 2007-02-10 |
| 1689733677 | John Mitchell Coats | Dentist | 7138 S Highland Dr, #109, Salt Lake City, UT 84121 | 2006-12-06 |
| 1124111323 | Mitchell G Rudd | Dentist | 1955 S 1300 E Ste 6, Salt Lake City, UT 84105-3684 | 2006-10-02 |
| 1245243542 | David Paul Koelliker | Dentist | 1953 E 5600 S, Salt Lake City, UT 84121-1351 | 2006-08-15 |
| 1215390885 | Sadler Endodontics Pllc | Dentist | 6364 S Highland Dr, #200, Salt Lake City, UT 84121-2117 | 2016-04-01 |
| 1861860173 | Utah Dental United | Dentist | 445 E 4500 S Ste 150, Salt Lake City, UT 84107-3101 | 2015-09-03 |
| 1316258346 | Laura L Milroy | Dentist | 500 Foothill Dr, Salt Lake City, UT 84148-0001 | 2010-06-24 |
| 1629226774 | Jeffrey B Kochevar | Dentist | 4970 S 900 E, Ste. E, Salt Lake City, UT 84117-5776 | 2008-09-03 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84105 |
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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.