PONY EXPRESS DENTAL LLC (NPI# 1609315480) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609315480 |
| Entity Type | Organization |
| Organization Name | PONY EXPRESS DENTAL LLC |
| Practice Address |
1308 E. Eagle Mountain Blvd Eagle Mountain UT 84005 |
| Mailing Address |
219 E 12300 S Suite I-5 Draper UT 84020-6970 |
| Practice Telephone | 8018767669 |
| Mailing Telephone | 8017897669 |
| Enumeration Date | 2017-02-14 |
| Last Update Date | 2017-03-16 |
| Authorized Official Name | DR. MICHAEL S TORNOW (COO) |
| Authorized Official Telephone | 5059474252 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | Y |
| Parent Organization Name | LAKE MOUNTAIN HEALTH, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
5015649 | UT | Ambulatory Health Care Facilities |
| Street Address |
1308 E. EAGLE MOUNTAIN BLVD |
| City | EAGLE MOUNTAIN |
| State | UT |
| Zip Code | 84005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922573856 | Eagle Mountain Children's Dentistry Pllc | Clinic/Center | 3435 Pony Express Parkway Ste. 130, Eagle Mountain, UT 84005 | 2018-10-08 |
| 1437650157 | Michael Hogue | Emergency Medical Technician, Basic | 2036 E Harkers Way, Eagle Mountain, UT 84005 | 2018-02-27 |
| 1376050682 | Bell Adult Healthcare and Wellness Pllc | Nurse Practitioner | 4719 E Silver Creek Way, Eagle Mountain, UT 84005 | 2018-01-08 |
| 1891201794 | Breaking Barriers Therapy Services LLC | Speech-Language Pathologist | 3756 E Barton Creek Dr, Eagle Mountain, UT 84005 | 2017-12-14 |
| 1346770617 | Mallory Lynn Hansen | Speech-Language Pathologist | 8981 N Skye Loop, Eagle Mountain, UT 84005 | 2017-06-19 |
| 1609130418 | Utah Addiction Centers | Substance Abuse Rehabilitation Facility | 2590 Prarie View Drive, Eagle Mountain, UT 84005 | 2012-06-26 |
| 1760763411 | Elizabeth A Pritt | Physician Assistant | 4095 E Pony Express Parkway, Suite 1, Eagle Mountain, UT 84005 | 2011-09-07 |
| 1902101587 | Benjamin Dean Jones | Social Worker | 4682 East Foxwood Drive, Eagle Mountain, UT 84005 | 2011-01-13 |
| 1407182892 | Jacob Chase Fowler | Pharmacist | 3435 E Pony Express Pkwy Ste 150, Eagle Mountain, UT 84005 | 2009-10-20 |
| 1861627937 | Matthew Philip Sudweeks | Physical Therapist | 3726 E Campus Dr., Ste: H, Eagle Mountain, UT 84005 | 2009-05-19 |
| Find all providers in zip 84005 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922573856 | Eagle Mountain Children's Dentistry Pllc | Clinic/Center | 3435 Pony Express Parkway Ste. 130, Eagle Mountain, UT 84005 | 2018-10-08 |
| 1447549837 | Kdb, LLC | Clinic/Center | 3688 Campus Dr Ste 220, Eagle Mountain, UT 84005-4669 | 2011-04-06 |
| 1518520964 | Rb Dmd Pllc | Clinic/Center | 3435 E Pony Express Parkway, Suite 110, Eagle Mountain, UT 84005-1204 | 2019-04-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922609015 | Corner Clinic Dental Stg | Clinic/Center | 2351 S River Rd Ste 4, St George, UT 84790-8749 | 2020-11-04 |
| 1124637665 | Pony Express Dental of Saratoga Springs | Clinic/Center | 2253 S. Talons Cove Drive, Saratoga Springs, UT 84045-8400 | 2020-07-30 |
| 1154947372 | Preston G. Hansen, Dds, Pllc | Clinic/Center | 7138 S Highland Dr Ste 211, Salt Lake City, UT 84121-3787 | 2020-06-23 |
| 1114549573 | Richfield Family Dental | Clinic/Center | 820 N Main St Ste 1, Richfield, UT 84701-1893 | 2020-05-08 |
| 1639790918 | Nic-utah County, LLC | Clinic/Center | 2230 N University Pkwy Ste 8b, Provo, UT 84604-6700 | 2020-04-28 |
| 1063032225 | Haven Dental LLC | Clinic/Center | 2685 N 1000 W, Pleasant View, UT 84414-2660 | 2020-04-17 |
| 1972139681 | Kayscreek Dental Pllc | Clinic/Center | 349 N Flint St, Kaysville, UT 84037-9807 | 2020-03-14 |
| 1831721240 | Sg Dental Pllc | Clinic/Center | 225 Skyhawk Dr, Wendover, UT 84083-4501 | 2020-02-05 |
| 1740829993 | V and S Dental LLC | Clinic/Center | 3816 W 13400 S Ste 200, Riverton, UT 84065-7888 | 2020-01-04 |
| 1124664834 | Simply Smiles Dental Utah | Clinic/Center | 2592 S 5600 W Ste 102, West Valley City, UT 84120-1274 | 2019-11-18 |
| Find all providers with the same taxonomy | ||||
| City | EAGLE MOUNTAIN |
| Zip Code | 84005 |
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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.