OrganizationActive
Clubhouse Pediatric Dentistry of West Jordan
NPI 1639654684 · Pediatric Dentistry · Midvale, UT
Clubhouse Pediatric Dentistry of West Jordan is a Pediatric Dentistry organization in Midvale, UT (NPI 1639654684).
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(68/100 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
Frequently asked questions
- What is Clubhouse Pediatric Dentistry of West Jordan's NPI number?
- Clubhouse Pediatric Dentistry of West Jordan's National Provider Identifier (NPI) is 1639654684, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Clubhouse Pediatric Dentistry of West Jordan?
- Clubhouse Pediatric Dentistry of West Jordan is classified in the NPPES registry as Pediatric Dentistry (Dental Providers).
- Where is Clubhouse Pediatric Dentistry of West Jordan located?
- Clubhouse Pediatric Dentistry of West Jordan's practice location on file with NPPES is 1108 E South Union Ave, Midvale, UT 84047-2904.
- What is Clubhouse Pediatric Dentistry of West Jordan's phone number?
- The practice phone number listed in the NPPES registry for Clubhouse Pediatric Dentistry of West Jordan is (208) 520-1514.
- Who is the authorized official for Clubhouse Pediatric Dentistry of West Jordan?
- The authorized official listed on Clubhouse Pediatric Dentistry of West Jordan's NPPES record is Jennifer Robison, Credentialing Coordinator. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Clubhouse Pediatric Dentistry of West Jordan's NPI active?
- Yes — Clubhouse Pediatric Dentistry of West Jordan's NPI (1639654684) is active in the NPPES registry as of the last update on 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.