Unknown Individual – Dentist, NPI 1003966169

Unknown Individual is a healthcare provider. based in West jordan, Utah. specializing in Dentist. They hold a License No. 1307709922 (UT). The NPI Number for Unknown Individual is 1003966169

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1003966169
Phone
(801) 566-4153
Address
9269 REDWOOD RD
Deactivation Date
25 September 2025
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 9269, Redwood Road, West Jordan, Salt Lake County, Utah, 84088, United States

    WEST JORDAN, UT 840886572

    Phone: (801) 566-4153

    Fax: (801) 566-1963

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 84088)

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Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1003966169 — the number used across U.S. healthcare to identify this provider.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Dentist. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on West Jordan, Utah.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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