SUGAR HOUSE DENTAL MANAGEMENT LLC (NPI# 1578928172) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578928172 |
| Entity Type | Organization |
| Organization Name | SUGAR HOUSE DENTAL MANAGEMENT LLC |
| Other Organization Name | THE SUGAR HOUSE DENTIST |
| Practice Address |
1955 S 1300 E Ste L2 Salt Lake City UT 84105-3675 |
| Practice Telephone | 8014869649 |
| Practice Fax Number | 8014869640 |
| Mailing Telephone | 8014869649 |
| Mailing Fax Number | 8014869640 |
| Enumeration Date | 2015-12-23 |
| Last Update Date | 2015-12-23 |
| Authorized Official Name | JARED THEURER (DOCTOR) |
| Authorized Official Telephone | 8014869649 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 305R00000X | Preferred Provider Organization | 9361973 | UT | Managed Care Organizations |
| Y | 305R00000X | Preferred Provider Organization | 337770 | UT | Managed Care Organizations |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | NPI | 1023423258 | 01 |
| UT | NPI | 1700897428 | 01 |
| Other Name | Type Code |
|---|---|
| The Sugar House Dentist | Doing Business As Name - Organization |
| Street Address |
1955 S 1300 E STE L2 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84105-3675 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659806487 | David Thorup | Dentist | 1955 S 1300 E Ste L2, Salt Lake City, UT 84105-3675 | 2017-04-30 |
| 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 | 305R00000X |
| Grouping | Managed Care Organizations |
| Classification | Preferred Provider Organization |
| A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/ October 1995, p. 62 |
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|---|---|---|---|---|
| 1841687126 | Intrafilrx | Preferred Provider Organization | 3920 S 1100 E Ste 210, Salt Lake City, UT 84124 | 2015-04-23 |
| 1316172596 | The Tooth Doctor | Preferred Provider Organization | 2180 E Fort Union Blvd., Salt Lake City, UT 84121 | 2009-05-18 |
| 1689819526 | Comp Today Lc | Preferred Provider Organization | 480 E 6400 S Ste 100, Salt Lake City, UT 84107-7594 | 2008-12-05 |
| 1023483252 | Bishop Family Dental | Preferred Provider Organization | 2120 E 3900 S, Suite 102, Salt Lake City, UT 84124-1771 | 2015-12-14 |
| 1730517517 | Bkp Dental | Preferred Provider Organization | 4066 S 4000 W, Salt Lake City, UT 84120-4040 | 2013-10-14 |
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| 1194273524 | New Horizon | Preferred Provider Organization | 1420 W 12600 Sputh, Draper, UT 84065 | 2016-09-14 |
| 1780037879 | Summit Senior Living LLC | Preferred Provider Organization | 5524 W 6200 S, Kearns, UT 84118-7925 | 2016-07-13 |
| 1790152551 | Helping Hands In-home Care LLC | Preferred Provider Organization | 690 N 3900 W, Cedar City, UT 84721-8130 | 2015-08-27 |
| 1407261506 | Utah Facial & Oral Surgery | Preferred Provider Organization | 3473 W South Jordan Pkwy, #4, South Jordan, UT 84095-6015 | 2014-06-26 |
| 1972928760 | Heros for Independent Living | Preferred Provider Organization | 655 Medical Dr, Suite 103, Bountiful, UT 84010-5168 | 2014-03-03 |
| 1265677678 | Edward K. Madsen, M.d., A Professional Corporation | Preferred Provider Organization | 590 E 100 N Ste 4, Price, UT 84501-2600 | 2008-12-14 |
| 1205008166 | James F. Allen, Mdpc | Preferred Provider Organization | 175 N 100 W Ste 101, Vernal, UT 84078-2057 | 2008-03-31 |
| 1760677520 | Ronald Baird | Preferred Provider Organization | 234 N Orem Blvd, Orem, UT 84057-6601 | 2007-09-13 |
| Find all providers with the same taxonomy | ||||
| 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.