| Clubhouse Pediatric Dentistry Of West Jordan | |
|
1108 E South Union Ave Midvale UT 84047-2904 | |
| (208) 520-1514 | |
| Not Available |
| Full Name | Clubhouse Pediatric Dentistry Of West Jordan |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1108 E South Union Ave, Midvale, Utah |
| Authorized Official Name and Position | Jennifer Louise Robison (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2085201514 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clubhouse Pediatric Dentistry Of West Jordan 1108 E South Union Ave Midvale UT 84047-2904 Ph: (208) 520-1514 | Clubhouse Pediatric Dentistry Of West Jordan 1108 E South Union Ave Midvale UT 84047-2904 Ph: (208) 520-1514 |
| NPI Number | 1639654684 |
|---|---|
| Provider Enumeration Date | 09/26/2018 |
| Last Update Date | 09/26/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639654684 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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