Provider Demographics
NPI:1437772498
Name:WHATCOTT, JORDAN AMES (DMD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:AMES
Last Name:WHATCOTT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5888 S 900 E STE 101
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1644
Mailing Address - Country:US
Mailing Address - Phone:801-281-8433
Mailing Address - Fax:801-281-8455
Practice Address - Street 1:5888 S 900 E STE 101
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-1644
Practice Address - Country:US
Practice Address - Phone:801-281-8433
Practice Address - Fax:801-281-8455
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11739705-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700315462OtherTYPE 2 NPI