MEDICARE: WASATCH PEDIATRICS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
3	1223G0001X	General Practice Dentistry
4	1223P0221X	Pediatric Dentistry
5	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1124102595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASATCH PEDIATRICS, INC

Provider Business Mailing Address
First Line	:	9071 S 1300 W STE 205
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-6725
Country	:	US
Telephone Number	:	801-453-9625
Fax Number	:	801-944-7347

Provider Business Practice Location Address
First Line	:	9071 S 1300 W STE 205
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-6725
Country	:	US
Telephone Number	:	801-453-9625
Fax Number	:	801-944-7347

Authorized Official
Title or Position	:	PROVIDER RELATIONS
Name	:	ALYSHIA RICE
Credential	:
Telephone Number	:	801-453-9625

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	12/22/2025

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Directions to “WASATCH PEDIATRICS, INC ” Practice Location

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