Data Notice: All results sourced from the public CMS NPPES NPI Registry (45 CFR Part 162), for healthcare administrative use only (credentialing, billing, insurance verification). Not for law enforcement or legal proceedings. Not affiliated with CMS, HHS, or the US Government. Verify critical details at npiregistry.cms.hhs.gov. No queries stored.
Export Provider Record NPI 1336404763
Modern Dental Professionals Utah, Pc
Organization Subpart: NO
Active
NPI Number1336404763
NPI TypeNPI-2 Organization
SpecialtyDentist, General Practice
Provider Details
NPI1336404763
NPI TypeNPI-2 Organization
StatusActive
Enumeration Date2012-07-11
Last Updated2024-04-08
Authorized OfficialLiliana Martinez
Credentialing director
Phone: 9493089792
Mailing Address8415 Datapoint Dr Ste 1020
San Antonio, TX 78229-3277
United States
Phone: (210) 929-2814 | Fax: (210) 615-3626
📍 View Map
Primary Practice Address1140 W Riverdale Rd, Suite D
Ogden, UT 84405-3787
United States
Phone: (801) 917-1502 | Fax: (801) 436-3222
📍 View Map
Taxonomy / Specialty
PrimaryTaxonomy Code & DescriptionStateLicense Number
Yes1223G0001X – Dentist, General Practice--
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About NPI 1336404763

Modern Dental Professionals Utah, Pc is an organization registered in the CMS NPPES NPI Registry with NPI number 1336404763. The primary specialty listed is Dentist, General Practice. The organization is located in Ogden, UT. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2012-07-11. All data is sourced directly from the official CMS NPPES public API and is updated daily.

Frequently Asked Questions

What is NPI 1336404763?

NPI 1336404763 belongs to Modern Dental Professionals Utah, Pc, a Dentist, General Practice in Ogden, UT. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.

Is NPI 1336404763 active?

The current status of NPI 1336404763 in the NPPES registry is Active. The record was last updated on 2024-04-08.

What specialty is NPI 1336404763?

NPI 1336404763 is classified under the taxonomy Dentist, General Practice. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.

How do I verify NPI 1336404763?

You can verify NPI 1336404763 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.

What address is on file for NPI 1336404763?

The primary practice address on file for NPI 1336404763 is 1140 W Riverdale Rd, Ogden, UT 84405-3787. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.

When was NPI 1336404763 issued?

NPI 1336404763 was first issued (enumerated) on 2012-07-11. The NPPES record was last updated on 2024-04-08.

Practice Location Map

Modern Dental Professionals Utah, Pc is located at 1140 W Riverdale Rd, Ogden, UT. Use the map below to find directions or verify the practice location.

📍 1140 W Riverdale Rd, Ogden, UT 84405-3787  ·  Open in Google Maps ↗

Related Healthcare Providers

The following providers share the same practice location, specialty, or state as Modern Dental Professionals Utah, Pc. All records sourced from the CMS NPPES registry.

Data Verified from CMS NPPES Last synced: 2026-08-12 · Source: npiregistry.cms.hhs.gov · 45 CFR Part 162