ROSE PARK PEDIATRIC DENTISTRY, PC (NPI# 1831338623) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831338623 |
| Entity Type | Organization |
| Organization Name | ROSE PARK PEDIATRIC DENTISTRY, PC |
| Practice Address |
55 N Redwood Rd Ste B Salt Lake City UT 84116-3174 |
| Practice Telephone | 8015192222 |
| Mailing Telephone | 8015192222 |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2009-02-18 |
| Authorized Official Name | DR. RICHARD RYAN JOHANSEN (OWNER) |
| Authorized Official Telephone | 8015192222 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | Y |
| Parent Organization Name | 49534949923 |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
49534949923 | UT | Dental Providers |
| Street Address |
55 N REDWOOD RD STE B |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84116-3174 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659667343 | Treagan Nephi White | Dentist | 55 N Redwood Rd Ste B, Salt Lake City, UT 84116-3174 | 2011-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689281818 | Devery White | Case Manager/Care Coordinator | 195 N 1900 W, Salt Lake City, UT 84116 | 2020-10-01 |
| 1114402377 | Felicia Marie Speer | Community Health Worker | 1303 Sir Phillip Dr, Salt Lake City, UT 84116 | 2018-10-03 |
| 1982144341 | Sharlena Schacht | Pharmacy Technician | 1040 North 2200 West, Salt Lake City, UT 84116 | 2017-03-06 |
| 1316300460 | Riverside Family Dental Care, Inc | Clinic/Center | 1614 W 700 N, Salt Lake City, UT 84116 | 2016-04-05 |
| 1174882856 | Marilyn Ross | Nurse Practitioner | 384 Wright Brothers Dr., Marilyn Ross Bld #2, Salt Lake City, UT 84116 | 2012-05-15 |
| 1720387137 | Lifetime Products Inc. | Durable Medical Equipment & Medical Supplies | 745 N Warm Springs Rd, Salt Lake City, UT 84116 | 2011-03-24 |
| 1811000276 | Kim Coston Christensen | Preventive Medicine | 2150 West 700 North, Kim C. Christensen D.o. Faa Sl/artcc Mfo, Salt Lake City, UT 84116 | 2006-08-17 |
| 1144705583 | Brian Larry Gashler | Family Medicine | 54 N 8th W, Salt Lake City, UT 84116 | 2018-10-02 |
| 1528350972 | Aliesha Shaw | Student in an Organized Health Care Education/Training Program | 26 South 2000 East, 5900, Salt Lake City, UT 84116 | 2011-05-04 |
| 1427035187 | Sarah Lynn Woolsey | Family Medicine | 1365 W 1000 N, Salt Lake City, UT 84116 | 2005-12-23 |
| Find all providers in zip 84116 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518478742 | Lcr Dental Sugar House | Dentist | 2068 S 2100 E Suite #a, Salt Lake City, UT 84108 | 2017-10-16 |
| 1316465255 | Creek Capital Cottonwood LLC | Dentist | 7050 S Highland Dr Ste 110, Salt Lake City, UT 84121-3764 | 2017-08-30 |
| 1558777151 | Jami Ballantine | Dentist | 55 N Redwood Rd, Salt Lake City, UT 84116-3121 | 2014-07-03 |
| 1346366283 | Hans Christian Reinemer | Dentist | 1963 E 5600 S, Salt Lake City, UT 84121-1351 | 2007-03-22 |
| 1578612602 | Debbie Lee Graham | Dentist | 620 E 2100 S, Salt Lake City, UT 84106-1828 | 2007-01-09 |
| 1720149453 | Jeffery K. Rupp | Dentist | 1548 E 4500 S, Suite 102, Salt Lake City, UT 84117-4209 | 2006-12-13 |
| 1982670568 | Val Joseph Cheever | Dentist | 1955 S 1300 E, Salt Lake City, UT 84105-3638 | 2006-02-24 |
| 1316438310 | Justin Moody | Dentist | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2018-05-24 |
| 1346761152 | Walker Dean Clark | Dentist | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2017-06-30 |
| 1972954790 | Audrey Sill | Dentist | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2016-06-22 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84116 |
Please comment or provide details below to improve the information on ROSE PARK PEDIATRIC DENTISTRY, PC.
| 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.