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NPI Code Detail

MEDICARE: WASATCH PEDIATRICS - SALT LAKE DENTAL

MEDICARE: WASATCH PEDIATRICS - SALT LAKE DENTAL
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
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry
21223S0112XOral and Maxillofacial Surgery (Dentist)
31223P0221XPediatric Dentistry

General Provider Information

NPI Number : 1982573366
Entity Type Code : Organization
Provider Name (Legal Business Name) : WASATCH PEDIATRICS - SALT LAKE DENTAL
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 : 3838 S 700 E STE 200
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-1466
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 : 11/03/2025
Last Update Date : 12/22/2025

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Directions to “WASATCH PEDIATRICS - SALT LAKE DENTAL ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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