MEDICARE: JORDAN AMES WHATCOTT DMD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	11739705-9922	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1700315462	OTHER		TYPE 2 NPI

General Provider Information

NPI Number	:	1437772498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN AMES WHATCOTT DMD

Provider Business Mailing Address
First Line	:	5888 S 900 E STE 101
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-1644
Country	:	US
Telephone Number	:	801-281-8433
Fax Number	:	801-281-8455

Provider Business Practice Location Address
First Line	:	5888 S 900 E STE 101
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-1644
Country	:	US
Telephone Number	:	801-281-8433
Fax Number	:	801-281-8455

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2020
Last Update Date	:	05/26/2020

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