CLUBHOUSE PEDIATRIC DENTISTRY OF JACKSON
NPI 1942775960
Dentist - Pediatric Dentistry in Jackson Hole, WY

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

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

Active since October 05, 2018

1130 US-89, JACKSON HOLE, WY 83001(307) 733-5439 Get Directions Write a Review

NPPES record last updated: October 5, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Clubhouse Pediatric Dentistry Of Jackson NPPES

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

CLUBHOUSE PEDIATRIC DENTISTRY OF JACKSON (NPI 1942775960) is a healthcare organization registered as a pediatric dentistry in Jackson Hole, Wyoming and active in the NPI registry since October 2018. The organization lists Courtney Matthew Jackson, Pediatric Dentist, as its authorized official.

NPPES Registry Identity

NPI1942775960

Entity TypeOrganization

Primary Taxonomy1223P0221X

Legal Business NameCLUBHOUSE PEDIATRIC DENTISTRY OF JACKSON

Location Address1130 US-89Jackson Hole, WY 83001-8701

Mailing Address3210 E 81st SIdaho Falls, ID 83406-8302 · (307) 733-5439

Phone(307) 733-5439

Organization SubpartNo

Authorized OfficialCourtney Matthew JacksonPediatric Dentist · (307) 733-5439

Enumeration DateOctober 5, 2018

✔ NPI 1942775960 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.

1130 US-89, Jackson Hole, WY 83001

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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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of Wyoming, UnitedHealthcare.Insurance ›

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Clubhouse Pediatric Dentistry Of Jackson's NPI number?

The NPI number for Clubhouse Pediatric Dentistry Of Jackson is 1942775960. It was assigned to this organization in the NPPES registry on October 5, 2018.

Where is Clubhouse Pediatric Dentistry Of Jackson located?

Clubhouse Pediatric Dentistry Of Jackson is located at 1130 Us-89, Jackson Hole, WY 83001. The listed phone number is (307) 733-5439.

What is Clubhouse Pediatric Dentistry Of Jackson's specialty?

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

What insurance does Clubhouse Pediatric Dentistry Of Jackson accept?

Health plans from Blue Cross Blue Shield of Wyoming and UnitedHealthcare list Clubhouse Pediatric Dentistry Of Jackson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Clubhouse Pediatric Dentistry Of Jackson was last updated on October 5, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.