CLUBHOUSE PEDIATRIC DENTISTRY OF WEST JORDAN (NPI# 1639654684) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639654684 |
| Entity Type | Organization |
| Organization Name | CLUBHOUSE PEDIATRIC DENTISTRY OF WEST JORDAN |
| Practice Address |
1108 E South Union Ave Midvale UT 84047-2904 |
| Practice Telephone | 2085201514 |
| Mailing Telephone | 2085201514 |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2018-09-26 |
| Authorized Official Name | MRS. JENNIFER LOUISE ROBISON (CREDENTIALING COORDINATOR) |
| Authorized Official Telephone | 2085201514 |
| Is Organization Subpart | Y |
| Parent Organization Name | CAPSTONE LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| Street Address |
1108 E SOUTH UNION AVE |
| City | MIDVALE |
| State | UT |
| Zip Code | 84047-2904 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649885096 | Wound Pros Utah | Durable Medical Equipment & Medical Supplies | 6975 Union Park Avenue, Suite 600, Cottonwood Heights, UT 84047 | 2020-09-12 |
| 1457965824 | Duy Danny Vo | Pharmacist | 7200 S State St, Midvale, UT 84047 | 2020-09-03 |
| 1619457314 | Tlcpo LLC | Counselor | 6975 Union Park Avenue Suite 600, Cottonwood Heights, UT 84047 | 2018-08-21 |
| 1700371606 | Heather Ivana Lawrence | Social Worker | 6856 700 E, Midvale, Ut 84047, Midvale,ut, UT 84047 | 2018-06-25 |
| 1285128942 | A&a Counseling | Counselor | 7602 S Main St, Midvale, UT 84047 | 2018-06-17 |
| 1396235339 | Hhalmid | Assisted Living Facility | 6968 S 700 E, Midvale, UT 84047 | 2018-05-15 |
| 1750879987 | Rosemarie Elaine Brinig | Counselor | 75 E. Ft. Union, C118, Midvale, UT 84047 | 2018-04-24 |
| 1861921140 | Olivia Devenport | Behavior Technician | 7434 S State Street, Midvale, UT 84047 | 2017-06-08 |
| 1376083071 | Marathon Health, LLC | Nurse Practitioner | 7259 South Bingham Junction, C/o Chg- Ut Health Center, Midvale, UT 84047 | 2017-02-28 |
| 1710436316 | Michael Naanes | Physical Therapist | 900 East 6900 South, Suite 100, Midvale, UT 84047 | 2016-09-25 |
| Find all providers in zip 84047 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962522714 | Albert L Evans | Dentist | 1275 E Fort Union Blvd, #220, Midvale, UT 84047 | 2007-03-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841891462 | South Davis Pediatric Dentistry LLC | Dentist | 59 W Pages Ln Ste 110, Bountiful, UT 84010-5988 | 2020-11-02 |
| 1376176198 | Happy Tooth Pediatric Dentistry, LLC | Dentist | 2453 E 3300 S, Millcreek, UT 84109-2725 | 2020-02-20 |
| 1750932273 | Michael R. Brown Dds Ms | Dentist | 1240 E 100 S Ste 120, St George, UT 84790-3079 | 2019-09-25 |
| 1609438357 | Children's Landing Pediatric Dentistry, PC | Dentist | 3855 W 7800 S Ste 200, West Jordan, UT 84088-5563 | 2019-07-02 |
| 1841766821 | Dry Creek Pediatric Dentistry | Dentist | 3300 N Running Creek Way F101, Lehi, UT 84043 | 2018-10-17 |
| 1639667801 | St. George Kids Dental At Snow Canyon | Dentist | 1100 Canyon View Dr Ste A, Santa Clara, UT 84765-5672 | 2018-04-24 |
| 1376044313 | Slpd Cottonwood LLC | Dentist | 7167 South Highland Drive, 200, Cottonwood Heights, UT 84121 | 2018-02-26 |
| 1013420553 | Kevin Brown Dmd, LLC | Dentist | 1030 S 1100 W, Suite B, Lehi, UT 84043 | 2017-11-07 |
| 1518478742 | Lcr Dental Sugar House | Dentist | 2068 S 2100 E Suite #a, Salt Lake City, UT 84108 | 2017-10-16 |
| 1952829897 | Creek Capital Oquirrh Park LLC | Dentist | 6973 S 4800 W Ste C, West Jordan, UT 84084-7927 | 2017-08-30 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.