1649848904 NPI number — DR. BRENDON THUESON TINGEY DMD

Table of content: DR. BRENDON THUESON TINGEY DMD (NPI 1649848904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649848904 NPI number — DR. BRENDON THUESON TINGEY DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TINGEY
Provider First Name:
BRENDON
Provider Middle Name:
THUESON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TINGEY
Provider Other First Name:
BRENDON
Provider Other Middle Name:
THUESON
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1649848904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14407 MURDOCK PEAK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERRIMAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84096-1855
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-792-2510
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11501 S 4000 W STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH JORDAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84009-6028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-701-2120
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  12797324-9923 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: DDS-09893 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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