CLUBHOUSE PEDIATRIC DENTISTRY OF WEST JORDAN
NPI 1639654684
Dentist - Pediatric Dentistry in Midvale, UT

Q: What is Clubhouse Pediatric Dentistry Of West Jordan's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Active since September 26, 2018

1108 E SOUTH UNION AVE, MIDVALE, UT 84047(208) 520-1514 Get Directions Write a Review

NPPES record last updated: September 26, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

On this page

About Clubhouse Pediatric Dentistry Of West Jordan NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CLUBHOUSE PEDIATRIC DENTISTRY OF WEST JORDAN (NPI 1639654684) is a healthcare organization registered as a pediatric dentistry in Midvale, Utah and active in the NPI registry since September 2018. The organization lists Jennifer Louise Robison, Credentialing Coordinator, as its authorized official.

NPPES Registry Identity

NPI1639654684

Entity TypeOrganization

Primary Taxonomy1223P0221X

Legal Business NameCLUBHOUSE PEDIATRIC DENTISTRY OF WEST JORDAN

Location Address1108 E SOUTH UNION AVEMidvale, UT 84047-2904

Mailing Address1108 E South Union AveMidvale, UT 84047-2904 · (208) 520-1514

Phone(208) 520-1514

Organization SubpartYesParent: Capstone Llc

Authorized OfficialJennifer Louise RobisonCredentialing Coordinator · (208) 520-1514

Enumeration DateSeptember 26, 2018

✔ NPI 1639654684 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers

Taxonomy Code1223P0221X

Definition

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.

1108 E SOUTH UNION AVE, Midvale, UT 84047

Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WILDFLOWER TELEHEALTH NETWORK INC.

Lactation Consultant, Non-RN