OrganizationActive
Clubhouse Pediatric Dentistry of West Jordan
NPI 1639654684 · Pediatric Dentistry · Midvale, UT
Provider details
- NPI number
- 1639654684
- Entity type
- Organization
- Primary specialty
- Pediatric DentistryDental Providers
- Parent organization
- Capstone LLC
- Organization subpart
- Yes
- Authorized official
- Jennifer Robison, Credentialing Coordinator(208) 520-1514
Specialties & taxonomies
Dental Providers
Profile Score
Established profile(67/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
7 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1108 E South Union Ave
Midvale, UT 84047-2904
Phone: (208) 520-1514
Street-level locationGet directions
Mailing address
1108 E South Union Ave
Midvale, UT 84047-2904
Registry dates
- Enumerated
- 2018-09-26
- Last updated
- 2018-09-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.